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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Low Hemoglobin Levels?

my 66 yr old husband, over the road trucker, had pylori big deep ulcer, had gastritis 9.4 hgb for the past 3 weeks, prostotitis, and farmers lung with a little cough, seems like it started with the Kansas fires and then he was about over the reaction to the smoke and then he had pain when he urinated, so by the time he got home from AZ, which is where our feedlot is, he was anemic 9.4 and breathing was shallow. Dr. put him on prednisone for the first week and and the second week put him on 6 days of antibiotic, then into the 3rd week finally put him on cirthosomething for prostitiis. Now today, day 24, since it all began, he was the worst feeling, of the past month. His Hgb has not come up after an iron rich greens and liver diet, no protein in his blood today, prostate good, coclonscopy today was clean, tested for leukemia which was not detected. ulcer healed up, black stools, chills once in awhile, he is very very weak. tomorrow he has tests again, iron, TSH, CMP CBC. chest and pelvis CT on tuesday next week. So, we don t know why the iron is not coming up and what the protein is low.
Mon, 17 Sep 2018
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Diabetologist,  's  Response
Hello



First and foremost, I will consider hemoglobin.

Possibility is that the diet he is taking is not getting to let the iron into the body. It is highly likely that the iron is being lost without getting absorbed.Besides, you said that he still has black stools. Now that may be a reason- he may still be loosing minor quantities of blood due to which the hemoglobin is not rising.



I think, he may have been on Syrup containing Sucralfate- this is commonly used medicine for the healing of ulcers. The downside is that this medicine reduces the absorption of the other medicines into the system. So as long as he is on the syrup, it is unlikely that oral medicines will help much.



He has been tested for iron. I would have suggested TIBC and Ferritin as well along with a peripheral smear. I would recommend using injectible iron therapy. That way the possibility of loss of iron from the gastric tract will be ruled out. Similarly, the gastrointestinal loss may have caused the protein levels to drop. Therefore, again, that may be a significant cause. Similar factors come into play when we consider protein absorption as well.



I would therefore again recommend using injectible form of protein to achieve a significant level and thereafter try to improve and maintain the levels by diet. I have tried to make it as simple as possible.



Hope I have answered your query. Let me know if I can assist you further.

Regards,

Dr. Saumya Mittal , Diabetologist
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What Causes Low Hemoglobin Levels?

Hello First and foremost, I will consider hemoglobin. Possibility is that the diet he is taking is not getting to let the iron into the body. It is highly likely that the iron is being lost without getting absorbed.Besides, you said that he still has black stools. Now that may be a reason- he may still be loosing minor quantities of blood due to which the hemoglobin is not rising. I think, he may have been on Syrup containing Sucralfate- this is commonly used medicine for the healing of ulcers. The downside is that this medicine reduces the absorption of the other medicines into the system. So as long as he is on the syrup, it is unlikely that oral medicines will help much. He has been tested for iron. I would have suggested TIBC and Ferritin as well along with a peripheral smear. I would recommend using injectible iron therapy. That way the possibility of loss of iron from the gastric tract will be ruled out. Similarly, the gastrointestinal loss may have caused the protein levels to drop. Therefore, again, that may be a significant cause. Similar factors come into play when we consider protein absorption as well. I would therefore again recommend using injectible form of protein to achieve a significant level and thereafter try to improve and maintain the levels by diet. I have tried to make it as simple as possible. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Saumya Mittal , Diabetologist