Dr. Yash Kathuria
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hello doctor,
I am consulting on behalf of a 103-year-old female patient who is experiencing extreme fatigue, low RBC, low Hgb, and has Stage 3 COPD. The patient's current medication includes Valsartan 160mg for blood pressure, which she has been taking for more than 50 years, and no other medications are being used. Iron levels are within the normal range, but homocysteine and B12 levels are high, with B12 being above the normal range. Other parameters such as magnesium, potassium, vitamin D, calcium, cholesterol, glucose, and TSH are reported as normal.
The primary concern is addressing the low RBC and high homocysteine levels with the goal of improving the BUN, creatinine, and EGFR rate, lowering homocysteine, and increasing the RBC count. The patient is already following a good nutrition plan and is trying to maintain it, but there is still concern about the persistently low RBC and elevated homocysteine levels. Additionally, she reports feeling tired all the time, with no other specific symptoms mentioned. Kindly help.
Thank you.
HI,
Welcome to icliniq.com.
I understand your concern regarding her low GFR (Glomerular filtration rate), low RBC (red blood cells), and high homocysteine levels. The GFR and creatinine levels depend on an individual's age, muscle mass, and protein consumption. To obtain the correct GFR value, Serum cystatin levels can be used to calculate it accurately. A GFR value of 35 does not necessarily mean she has chronic kidney disease (CKD); it could be age-related.
It is essential to consider her urine routine microscopy test. If protein is present in the urine, kidney involvement can be considered, and further evaluation may be necessary. A kidney ultrasound (USG) can also provide valuable information about the kidney structure.
Furthermore, her hemoglobin and RBC mass are not excessively low, which could be correlated with her age, and this level of hemoglobin should not cause fatigue.
Elevated homocysteine levels often result from increasing age and low levels of folic acid, vitamin B12, and B6. However, since her B12 level is good, folic acid and B6 supplementation should be initiated to bring the homocysteine levels down.
Could you provide information on her oxygen level, any swelling in her legs, urine output, and if she has any complaints of palpitations? These details will assist me in guiding you further.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
I am providing her a daily vitamin supplement of B complex with iron. There is no leg swelling, although slight feet swelling may occur at times. Her oxygen level is consistently very good, usually at 99 and never less than 98. There are no palpitations, and urine output is good and clear with a slight yellow tinge. She has no complaints about any symptoms other than fatigue.
I have attached the urinalysis reports.
Thank you.
Hello,
Welcome back to icliniq.com.
Based on the above reports (attachment removed to protect the patient’s identity), I can assure you that there is no significant problem that she is facing. It is most likely age-related fatigue and exhaustion. The only cause that can be ruled out is her cardiac status; sometimes cardiac dysfunctioning may lead to fatigue. If that is also fine, it means there is nothing to worry about. As she is a hypertensive patient, long-term cardiac complications may arise if blood pressure is uncontrolled. I am confident that her blood pressure is also within the normal range. You can consider going for echocardiography to rule out any cardiac concerns. Otherwise, she is in a good state of health, considering her age. Fatigue can be explained by her age, as I cannot find any other apparent reason for it.
I would suggest you keep her hydrated, and if her blood pressure becomes low, then the medication dose may need to be adjusted.
I hope this helps. If you have any further questions or concerns, feel free to ask.
Thanks and take care.
Was this conversation helpful?
Same symptoms don't mean you have the same problem. Consult a doctor now!
Family Physician
Related Questions
Renal Hyperfiltration - An Overview
My wife is pregnant and her T3 value is high. What to do?
I am a diabetic and hypertensive with less hemoglobin. Please help.
Why am I having severe fatigue and bone pain with abnormal findings in my blood smear?
I have severe fatigue with positive ANA test and bumpy rash on abdomen. Please help.
Do I have to fast before I go for GFR test?
Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.
This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy
