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Treatment for reduced HEMOGLOBIN and HEMATOCRIT.

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Hi, my grandfather's blood test results came today. The haemoglobin level is at 6 and hematocrit at 21% .Around 12 days back his haemoglobin level was 9, and since then he's been taking supplements prescribed by the doctor. The doctor has advised to take a CT scan tomorrow and then take the next step.
Would like your thoughts what should be done and whether he should be admitted to the hospital immediately?

I've uploaded the results with this mail.


Category: Internal Medicine Specialist

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Yes a hemoglobin of 6, and since it's been falling rapidly, it is better that your grandfather gets blood transfusion done if it is possible. In fact anything below 5, is considered to be a critical value, and can lead to hypoxia, shock, heart failure (e.t.c )
Is it spontaneous? Or your grandfather suffered some trauma recenlty?
What supplements is he taking? His iron levels are supposed to imporve after the supplement, however that has not happened.
Does he have any symptoms? Fever/Loss of weight/ Diarrhea/Chills and rigors?
Do reply as a follow up,
Regards.


Patient replied :

Thanks for getting back! These are the tablets he's taking at the moment. Absolutely 3g vitamin tablet, gerifilo for urine which hes been taking regularly. After the drop in haemoglobin daxorange twice a day and folvite once a day. The blood test which was taken on the 3rd of September was at 7.2 and he was put on iron tablet and the results on 23rd Sep I had attached previously. I don't think there was a shock or any kind of trauma. His motion was irregular which is why we had him checked but has been normal now. Fatigueness is prevalent though. Would blood transfusion be advised? Hes 81 as well. Would appreciate your thoughts? Should we wait to take te CT scan and then take a decision ? Thanks a lot. Look forward to hearing from you.


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,
Yes it is better that he gets a transfusion because 6 is too low and it can produce a lot of complications.
He has already taken dexorange and folvite and still it is getting low.
If there is no fever or blood in stool, most infectious causes can be ruled out.
So he needs proper evaluation. LFT/RFT/ CT SCAN ( as you mentioned )/Serum elcetrolytes/ Stool examination ( for occult blood ). The loss of blood has to be localised.
Please dicsuss with his physician and discuss the possibility of a transfusion. I definitely feel his hemoglobin needs to come up to at least 10. Then his fatigueness will disappear.
Regards.


Patient replied :

Thanks a lot for your information.
Would blood transfusion be the only option at this stage and would there be any complications as he's already 81? Are there any other methods other than transfusion that could help increase the blood count?
Regards,
Adnan


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Blood transfusion seems logical since his parameters have dropped considerably.
But it's still not critically low, so i would suggest first the reason needs to be found out.
So investigations like LFT/RFT/ Serum Electrolytes,/ Stool for occult blood/ CXR/ECG/ CT SCAN needs to be done. A thorough evaluation is definitely necessary here.
So get it done as soon as possible. Assessing his reports, his local physician will be the best judge whether to start transfusion or not. The only other option is IV iron infusion. That can be decided after the reports.
Regards.


Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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