Improving Your Hemoglobin: Solutions for Low Levels
A few pointers can clear the air...
The English version of this topic is here
এই টপিকের বাংলা লিংকের জন্য এখানে ক্লিক করুন ( link will be live once that material is published )
👉🏽 Is your hemoglobin low, and are you wondering how to improve it quickly?
If you're reading this, either ➤ you're curious or ➤ your hemoglobin is less than 8 grams per deciliter, or ➤ you're probably considering blood transfusion, intravenous iron therapy, or oral iron tablets/capsules.
👉🏽 Know Three Key Principles:
Every good thing in life comes with risks. Generally, oral iron replenishment has the lowest risks but is the slowest method to improve hemoglobin. Intravenous iron improves levels faster than the oral route. Blood transfusion is the quickest way to increase hemoglobin but is considered a last practical resort.
Low hemoglobin puts extra strain on your heart, as it has to work harder to ensure the whole body gets oxygen. Younger patients tend to tolerate this strain longer than older patients. Many patients may not show symptoms until the condition is advanced. Therefore, low hemoglobin needs to be treated promptly. Uncorrected low haemoglobin delays recovery from surgery.
In our practice, blood transfusion is offered as a last resort. It is important to assess the risks and benefits of a blood transfusion carefully. Without your consent, we cannot proceed with a blood transfusion.
💎 Basics
✅ Normal Hemoglobin for women: 12-16 gram per deciliter ( g/dL ). Indian women tend to have lower normal hemoglobin level than this. The varies between ethnicity and food habit.
✅ Hemoglobin carries oxygen from lungs to all cells of your body.
💎 Common Questions
👉🏽 Question 1: My hemoglobin is stable and 10 grams per deciliter or above.
If you are not losing blood and are in a stable condition, your body can manage this hemoglobin level well. If you need iron replenishment, oral iron and vitamin therapy is usually adequate.
👉🏽 Question 2: My hemoglobin is between 8 and 10 grams per deciliter. What are my options?
If you are not losing blood, are stable, and not in the postoperative period, you may choose oral iron and vitamin tablets or intravenous iron therapy. If you are facing surgery or recovering from it, for faster relief to your heart, blood transfusion might be offered. However, we still offer blood transfusion as a last option.
👉🏽 Question 3: My hemoglobin is between 6 and 8 grams per deciliter.
With this level, your heart is pumping extra hard. If a doctor determines your health requires a fast hemoglobin correction, you may be offered a blood transfusion. Blood transfusion improves haemoglobin within a few hours to a few days. Oral tablets and intravenous iron increase hemoglobin relatively slowly, taking weeks to reach a reasonable level of 10 grams per deciliter.
👉🏽 Question 4: My hemoglobin level is below 6 grams per deciliter.
In this situation, urgent hospital admission and blood transfusion may be necessary. This decision is based on a discussion with your doctor. At this low level, the heart is closer to failure due to low oxygen-carrying capacity. Discuss the therapy benefits and risks with your doctor.
👉🏽 Question 5: Overview of Blood Transfusion Process
Blood transfusion is done in a hospital, ideally very slowly to allow the heart and kidneys to accommodate the changes. You must sign a consent form. Cross-matching, the process to match your blood with donor blood, takes several hours.
The transfusion process itself should ideally not start after sunset unless in immediate danger.
Anti-allergic and risk-reducing medications may need to be administered around the time of the transfusion. Hemoglobin is best rechecked a few hours after the last blood transfusion. As for a separate patient information link/booklet for blood transfusion.
👉🏽 Question 6: Overview of Intravenous Iron Therapy
Taking iron through a vein is considered a second-line alternative to oral iron tablets. After hospital admission, we will monitor for allergic reactions post-therapy. A loading dose of iron is given slowly to ensure tolerance. Hemoglobin levels will improve over the next few weeks. Recently IV iron therapy has received much attention due to improved special iron compound and lower allergy reaction level [ ‣ ]
👉🏽 Question 7: Oral Iron Therapy
Oral iron therapy will improve hemoglobin slowly over several weeks. Our digestive system is not very efficient at absorbing the full amount of iron from tablets or dietary sources. Consuming citrus juice can improve iron absorption.
Dietary plant sources of iron are often bound with phytate, which prevents absorption. Relying solely on dietary sources is not sufficient when you need to improve hemoglobin fast. Dietary sources , however, are very helpful for day to day maintenance of health.
👉🏽 Question 8: Is My Treatment Complete Once The Haemoglobin Is Good?
Not really. Body first fills up ➤‘showroom’ iron and then fills up ➤‘warehouse’ store of iron of body. Hemoglobin level is a measure of the body's ‘showroom’ iron levels. Once Hemoglobin normalises, the body's deeper iron warehouse, particularly in the bone marrow, still need to be replenished. This process can take up to 4 to 6 additional weeks for a normal patient once hemoglobin has achieved its normal level.
Therefore, you still need a supply of iron to replenish the body’s iron stores in the bone marrow. This also includes vitamins such as B12 and folate, which are essential components in the bone marrow's hemoglobin formation process. Iron + Vitamin B12 + Vitamin Folate + dietary nutrition = Haemoglobin. If your bone marrow is not adequately filled with iron and vitamins, your hemoglobin level might drop unexpectedly again, soon.
Additionally, once your hemoglobin is normalized, further investigation is needed to determine the cause of the initial drop. Common reasons for women include gynaecological bleeding or surgery. Complex cases may involve multiple sources of blood loss, such as hidden loss from the digestive tract, or issues with bone marrow function. In uncommon cases, a multidisciplinary approach, including physicians and hematologists, may be necessary.
👉🏽 Question 9: How Do I Know If I Have Adequate Haemoglobin?
Test your hemoglobin as a part of your CBC blood test.
👉🏽 Question 10: How Do I Know If I Have Adequate Iron In Body?
To check adequate Iron Levels, testing hemoglobin alone is not enough. A serum iron level test is helpful but may be costly. Because of cost it is not commonly offered but gives a better picture than hemoglobin, ferritin level or total iron binding capacity test etc. Discuss with your doctor whether if ‘serum iron’ test is necessary for you.
👉🏽 Question 11: Time Sensitive Blood Transfusion & Surgery
If blood transfusion or IV iron therapy is needed before surgery, various logistical factors must be considered. Things may work exactly as planned. These factors include the admission date, time for crossmatching at the blood bank, blood availability, your body’s response to therapy, rate of hemoglobin improvement, and the unpredictable availability of surgery slots.
Discuss with your doctor how to optimize your hospital stay and costs. If your hemoglobin level is not adequately high, the surgery will need to be postponed for your safety. We understand that you may wish to have the surgery done as soon as possible. However, it is not recommended to put additional stress on your heart’s already overstretched pumping ability. Talk to your doctor for further guidance.
👉🏽 Question 12: I Have Religious or Personal Objection To Blood Transfusion
Please inform your doctor as early as possible- as you may need to referred to another centre or hospital. In certain circumstances not having blood transfusion may put extra strain on heart and jeopardise your health. This is despite the potential risks of blood transfusion. Blood products can be life saving at times. Doctors have duty to save lives.
Certain groups of population ( i.e. Jehovah Witness ) or some patients ( out of their personal anecdotes ) will refuse blood transfusion, no matter what. They can sign advanced directive via court ordering hospitals to withhold blood transfusion even in critical state, no matter what.
We fully will respect your decision.
However, due to our constraints, we are unable to initiate treatment if a patient has made a final decision to refuse blood product transfusion altogether.
Medical science is not advanced enough to guarantee that at certain points in treatment, a blood transfusion will not be necessary. This policy is clear and non-negotiable.
We will refer you to higher centres in the country where you can proceed with your elected treatment.
👉🏽 More Questions?
Always feel free to ask your doctor any questions. If you have important questions, get them answered before being admitted. I will be be happy to assist you and address any concerns you may have. Wishing you a great recovery.
❝Quote of The Day:
“Take one step in the direction of your dreams and watch the Universe perform miracles to help you.” —Alexandra Domelle
This is an impartial , unsponsored health information. For public awareness and not a replacement of Medical Advice.
Reference:
[1]
M. Auerbach, A. Gafter-Gvili, and I. C. Macdougall, “Intravenous iron: a framework for changing the management of iron deficiency,” The Lancet Haematology, vol. 7, no. 4, pp. e342–e350, Apr. 2020, doi: 10.1016/S2352-3026(19)30264-9.
[2]
S. Ghosh et al., “Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age,” Eur J Clin Nutr, vol. 77, no. 10, pp. 966–971, Oct. 2023, doi: 10.1038/s41430-023-01308-5.
[3]
A. Helman, “IV Iron for Anemia in Emergency Medicine | EM Cases,” Emergency Medicine Cases. Accessed: Jan. 15, 2025. [Online]. Available: https://emergencymedicinecases.com/iv-iron-for-anemia-in-emergency-medicine/