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How to increase hemoglobin levels?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At June 11, 2023
Reviewed AtDecember 19, 2023

Patient's Query

Hi doctor,

My hemoglobin level is 9.8 g/dl. It did not increase after taking Ferrous Ascorbate or Folic Acid capsules. I have also taken B12 injections. I have been also suffering from diabetes for the last 20 years.

Hi,

Welcome to icliniq.com.

I understand your concern.

In your case, a low red cell count is also contributing to low hemoglobin. Some more investigations are needed. Get a reticulocyte, stool with occult blood, urine test, especially for hematuria, and ferritin tests. You might need recombinant erythropoietin injection to build up hemoglobin. Meanwhile build up your vitamin B12, folic acid, pyridoxine, and iron levels. Iron should be used intravenously preferably. Please read my blog on low hemoglobin and then make further queries. Low hemoglobin is also called anemia.

  1. Grade 1 anemia: Hemoglobin less than normal for age and gender up to 9.9 g/dL. This is mild anemia. No investigation is needed. Just improve diet, give hematinics. Rule out renal disease, liver disease, thyroid disease, thalassemia minor, or any drug-induced cause.
  2. Grade 2 anemia: Hemoglobin range from 8.9 to 9.8. This is moderate anemia. Investigate causes that might be combined with nutritional deficiency or other above-mentioned causes. No blood transfusion is needed at this level.
  3. Grade 3 anemia: Hemoglobin range from 7.9 to 8.8. This is moderately severe anemia. Causes may be hemolysis, acute or chronic blood loss, along with the above-mentioned causes. No need for transfusion at this level unless a surgical emergency is there.
  4. Grade 4 anemia: Hemoglobin ranges from 6.9 to 7.8. This is severe anemia. However, no transfusion is needed even at this level unless there is some surgical emergency. The causes include thalassemia intermedia or major, hereditary spherocytosis, and above mentioned ones.
  5. Grade 5 anemia: Hemoglobin level 5.9 to 6.8. This is very severe anemia. A blood transfusion may be needed according to the cause. If there is a production disorder, transfusion is needed and also in thalassemia major. No need for transfusion in mere combined nutritional deficiency or renal disease. Also, assess the cardiovascular system at this level.
  6. Critically low hemoglobin or grade 6 anemia: Hemoglobin level less than 5 g/dL. Transfusion is needed regardless of the cause.

The workup for anemia includes CBC (complete blood count) with red-cell indices, platelets, reticulocytes, peripheral blood smear report, hematuria workup, melena, hematemesis, hemoptysis workup, bone marrow biopsy report, ferritin, vitamin B12 and red blood cell folate levels.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mubashir Razzaq Khan
Dr. Mubashir Razzaq Khan

Hematology

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