Can Anemia Cause Dizziness in a Male Patient with Hemoglobin 118 g/L?
Yes, a hemoglobin of 118 g/L (11.8 g/dL) in an adult male meets the diagnostic criteria for anemia and can absolutely cause dizziness, along with other symptoms like syncope, exercise dyspnea, headache, vertigo, chest pain, and fatigue. 1
Why This Hemoglobin Level Causes Symptoms
This patient is anemic by standard definitions. The World Health Organization and multiple clinical guidelines define anemia in adult males as hemoglobin <130 g/L (13.0 g/dL), making this patient's value of 118 g/L clearly below the threshold. 1, 2, 3
Dizziness (vertigo) is a well-recognized symptom of anemia. Clinical practice guidelines specifically list vertigo as a common complaint in anemic patients, alongside syncope, headache, exercise dyspnea, chest pain, and fatigue. 1
The severity of symptoms depends on both the degree of anemia and whether it developed acutely or chronically. Acute anemia is typically more symptomatic than chronic anemia at the same hemoglobin level, as patients with chronic anemia develop compensatory mechanisms. 4, 5
Clinical Context Matters
The key distinction is whether this anemia is acute or chronic:
If the hemoglobin dropped rapidly (acute blood loss, hemolysis), the patient is more likely to be symptomatic with dizziness, even at this level. 4
If the anemia developed gradually over months (nutritional deficiency, chronic disease), the patient may have adapted somewhat, though symptoms can still occur. 5
Immediate Evaluation Required
This male patient requires prompt evaluation to determine the cause of anemia, as it is never a diagnosis itself but always represents an underlying condition. 6, 7
Essential initial workup includes:
Complete blood count with red cell indices and reticulocyte count to classify the anemia by mean corpuscular volume (MCV). 2, 3
Iron studies (serum ferritin and transferrin saturation) to assess for iron deficiency, the most common cause in men. 2, 3
Vitamin B12 and folate levels to rule out nutritional deficiencies. 2, 8
Peripheral blood smear examination to evaluate red blood cell morphology. 1, 3
Critical pitfall to avoid:
In adult men and postmenopausal women, iron deficiency anemia should prompt gastrointestinal evaluation for occult blood loss and potential malignancy. Bidirectional endoscopy is strongly recommended to exclude gastrointestinal cancer, as asymptomatic colonic and gastric carcinoma commonly present with iron deficiency anemia. 1, 2, 3
Treatment Considerations
Address the underlying cause first. Simply treating the anemia without identifying its etiology is inadequate and potentially dangerous. 6, 7
Symptomatic management may be needed. While this hemoglobin level (118 g/L) does not typically require transfusion in a hemodynamically stable patient, oral iron supplementation should be initiated if iron deficiency is confirmed. 2, 8
Transfusion is reserved for severe cases. Blood transfusions should only be considered for hemoglobin ≤51 g/L (5.1 g/dL) with hemodynamic instability or severe symptoms, or for symptomatic patients with hemoglobin ≤80 g/L (8.0 g/dL). 2, 8