From the Guidelines
Low hemoglobin levels can cause a range of symptoms, including fatigue, weakness, pale skin, shortness of breath, dizziness, headaches, cold hands and feet, chest pain, and irregular heartbeat, and it is essential to seek medical attention for proper diagnosis and treatment. These symptoms occur because hemoglobin carries oxygen throughout the body, and when levels are low, tissues and organs don't receive adequate oxygen 1. Severe anemia may cause brittle nails, hair loss, restless legs syndrome, and a craving to eat non-food items (pica). Symptoms vary based on how quickly anemia develops, its severity, and underlying causes.
Common Causes and Diagnosis
Common causes of low hemoglobin include iron deficiency, vitamin deficiencies (B12, folate), chronic diseases, blood loss, and genetic conditions. According to the guidelines for the management of iron deficiency anaemia, any level of anaemia should be investigated in the presence of iron deficiency, and the lower the haemoglobin, the more likely there is to be serious underlying pathology and the more urgent is the need for investigation 1. Red cell indices provide a sensitive indication of iron deficiency in the absence of chronic disease or haemoglobinopathy, and serum ferritin is the most powerful test for iron deficiency 1.
Treatment and Management
Treatment depends on the cause but may include iron supplements (typically 325mg ferrous sulfate 1-3 times daily), vitamin supplements, or addressing underlying conditions. While waiting for medical care, eating iron-rich foods like lean meats, beans, and leafy greens, and vitamin C-rich foods to enhance iron absorption can be beneficial. The European Erythropoietin Symposium recommends maintaining serum ferritin at greater than 100 ng/mL and transferrin saturation at greater than 20% during Epoetin therapy 1.
Key Recommendations
- Seek medical attention for proper diagnosis and treatment if symptoms of low hemoglobin are experienced.
- Eat iron-rich foods and vitamin C-rich foods to enhance iron absorption.
- Iron supplements and vitamin supplements may be prescribed based on the underlying cause of anemia.
- Regular monitoring of iron status and hemoglobin levels is essential to prevent and manage anemia 1.
From the Research
Low Hemoglobin Symptoms
- Low hemoglobin levels, commonly referred to as anemia, can present with nonspecific complaints 2
- The symptoms of anemia can vary depending on whether the condition is acute or chronic, with acute anemia often associated with blood loss and symptoms, while chronic anemia may be well tolerated and discovered coincidentally 2
- A systematic approach to evaluation is necessary to determine the etiology of anemia, with consideration of the patient's history and laboratory values 3
- The severity of anemia can impact clinical outcomes, particularly in critically ill patients, although the specific threshold for transfusion is uncertain 2
Diagnosis and Evaluation
- A differential diagnosis of low hemoglobin level is extensive and requires an organized approach to avoid overlooking potential causes 3
- The diagnosis of anemia may be clearer in unstable patients, but can be more difficult to determine in stable patients due to the many potential causes of low hemoglobin level 3
- Evaluation of anemia in the emergency department involves determining whether the problem is acute or chronic, and applying a systematic approach to determine the etiology 2
Treatment and Management
- The treatment of anemia depends on the underlying cause, with certain anemias having well-defined treatment options, such as sickle cell disease 2
- A restrictive transfusion strategy, transfusing patients with a hemoglobin level < 6-8 g/dL, is associated with better outcomes than a more liberal transfusion strategy 2
- Empiric use of nutritional supplements to treat anemia of uncertain etiology is discouraged 2