Low Hemoglobin Levels, or anemia, is a symptom of an underlying illness. When hemoglobin falls below 7.0 g/dL, symptoms appear. The kidney produces erythropoietin (EPO) hormone, which promotes the synthesis of red blood cells (RBCs). Low (EPO) levels have been identified in anemic patients with renal failure. This article describes how anemia is evaluated and treated, as well as the role of the inter-professional team in managing patients with this illness.
Normal Hemoglobin Level
Normal Hemoglobin (Hgb)-specific laboratory cut-offs are generally as follows:
- 5 to 18.0 g/dL in males.
- 0 to 15.0 g/dL in women.
- 0–16.0 g/dL in children
During pregnancy, it varies depending on the trimester, although it is usually greater than 10.0 g/dl.
Any condition that leads to low hemoglobin levels, will result in the appearance of anemia symptoms.
Causes of Low Hemoglobin
RBCs originate in the bone marrow and are ejected into the bloodstream. Approximately 1% of RBCs are eliminated from circulation daily. Anemia is caused by an imbalance in the production and removal or destruction of RBCs, which means low hemoglobin levels.
The primary mechanisms underlying anemia are given below:
-
Increased RBCs destruction:
-Blood Loss
- Acute: bleeding, surgery, trauma, menorrhagia.
- Chronic- excessive menstrual bleeding, chronic gastrointestinal blood losses (in the presence of hookworm infestation, ulcers, and so on), and urine losses (BPH, renal cancer, schistosomiasis).
-Hemolytic Anemia
- Acquired: immune-mediated, infection, microangiopathy, blood transfusion-related, and secondary to hypersplenism.
- Enzymopathies, hemoglobin problems (sickle cell), defects in red blood cell metabolism (G6PD deficiency, pyruvate kinase deficit), and defects in red blood cell membrane formation (hereditary spherocytosis and elliptocytosis).
-
Defect in Erythropoiesis
with microcytic, normocytic, normochromic, and macrocytic anemia.
Symptoms of Anemia
Mild anemia may be asymptomatic, but the classical symptoms of anemia are:
-Weakness
-Tiredness
-Lethargy
-Restless legs
-Shortness of breath.
-Chest pain.
What Happens When Hemoglobin Drops Too Low?
In the case of critically low hemoglobin level, which means severe anemia, the following symptoms appear:
- Feeling lightheaded or dizzy
- Bluish discoloration in the eye whites
- Fragile nails
- Jaundice-like pale or yellowing skin
- Reduced sexual desire
- Pica syndrome; which is the urge to consume non-food objects.
- A painful or inflamed throat.
- Ulcers in the mouth
- Extreme fatigue even with small efforts.
- Shortness of breath gets worse.
Signs of Anemia
- Anemia can be diagnosed through various signs, including cool skin, tachycardia, hypotension, lymphadenopathy, glossitis, cheilitis, abdominal exam, splenomegaly, hepatomegaly, and sickle cell anemia.
- The diagnosis includes a chest exam, a neurological exam, and a skin examination. Hemoglobin levels below 7–9 mg/dL are indicative of anemia.
- Rectal and pelvic exams are often overlooked but are crucial for detecting neoplasm.
Read Also: Dangerously Low Ferritin Levels
Treatment
- Anemia management involves treating the underlying causes, such as acute blood loss, nutritional deficiencies, bone marrow and stem cell defects, chronic disease, and increased red blood cell destruction.
- Treatment includes IV fluids, oxygen, iron supplementation, bone marrow transplantation, chronic disease, autoimmune and rheumatological conditions, and hemoglobinopathies like sickle anemia.
- Patients with cardiovascular disease require higher hemoglobin goals. Oral iron supplementation is the most common method for iron repletion, with IV iron being beneficial for rapid increases.
- Treatment also includes splenectomy, blood transfusions, exchange transfusions, hydroxyurea, and antifibrinolytic agents for life-threatening bleeding.
In summary, Anemia is a complex condition influenced by various diseases, necessitating interprofessional teamwork between patients, primary care providers, and consultants. It requires medication, lifestyle modifications, and frequent follow-ups to prevent complications. Pharmacists and nurses educate patients on medication compliance, side effects, and drug interactions, ensuring optimal outcomes in anemia cases.
References
- Turner, J., Parsi, M., & Badireddy, M. (2023). Anemia. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved January 2025.
- Ianni, C. M., McDowall, M. P., & Zuska, I. A. (2021). Differential diagnosis of low hemoglobin. Dimensions of Critical Care Nursing, 40(4), 204–209.
