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What is the cause of very low haemoglobin levels?

Q: I am working in Singapore for the past 10 months. I feel tired even if I climb 5-6 steps. I had my blood test done and found that my haemoglobin is 8.6%. I got an abdomen scan done and found that I have a fatty liver. I am 177 cm tall and I weigh 78 kg. I used to weigh 82 kg earlier. Doctors in India said that there is nothing to worry and I should take iron tablets/injections. The doctors in Singapore told me all the reasons. They say that this could be either due to vitamin B12 deficiency or some serious problem in the bone marrow. Please suggest me the right path? Will taking iron tablets improve my health?

A:A haemoglobin value of 8.6 g/dl is a moderately severe anaemia for an adult male. You have not mentioned the complete blood counts in your report (Hb, RBC, PCV, MCV, MCH, MCHC, TLC & platelets) which provide a plethora of information. Iron deficiency will cause a low MCV while vitamin B12 deficiency will lead to an elevated MCV. In any case, anaemia is not a diagnosis and is only a symptom of a disease. Your physician has to investigate you and find out why you are so anaemic. The possibility of blood loss from the gastro-intestinal tract, drug ingestion, diet and personal habits, etc. have to be looked into to find the reason. This should not be neglected and taking iron or folate may correct the anaemia temporarily without really treating the primary cause. In case of refractoriness, a bone marrow examination will be required.

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