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Why is my mother’s haemoglobin level not improving?

Q: My 49 years old mother underwent open cholecystectomy and also urethral dilation as she was detected with bladder outlet obstruction a month back. The ultrasound report states that her right kidney is not working properly but left one is working fine. Her haemoglobin level is fluctuating between 6.8 and 7.5. She takes Wepox 4000 mg once in a week and after taking 4 vials, it is still showing 7.5. Will it take time for her haemoglobin level to improve? Her haemoglobin electrophoresis test was also done and it showed almost normal results. Please advise.

A:From the history provided, it seems that your mother who is approximately 49 years old is having chronic anaemia, along with a single functioning kidney. The right kidney, which is dysfunctional, seems to have become so on account of bladder outlet obstruction, which in turn was due to urethral stricture. Generally, a single kidney produces adequate erythropoietin to stimulate the bone marrow to produce adequate red cells and consequently the haemoglobin. Why your mother is still anaemic would need further investigations. This would need a detailed peripheral smear examination with reticulocyte count and CBC and if required a bone marrow examination. I would therefore recommend a visit to a clinical haematologist for proper evaluation and only then treatment could be planned.

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