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Dr Basu
Dr Basu, Experienced Specialist
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Experience:  MD
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My hemoglobin (HGB) is 11.4 g/dl. It was 11.8 g/dl

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My hemoglobin (HGB) is 11.4 g/dl. It was 11.8 g/dl in Jan. A year ago it was 12.5 g/dl. The indicies are normal. RBC is 3.87 x 10/6, which is low. My Iron, TIBC, and erythropoietin are normal. I am taking a multi vitamin.I don't seem to have any symptoms, should I be pursuing the low hemoglobin? I am a medical labortorian.

Submitted: 5 years ago.
Category: Medical
Expert:  Dr Basu replied 5 years ago.

Thanks for your question.

Also get checked for vitamin B12 and folate deficiency --other common causes of anemia.

Hereditary hemoglobinopathies ( abnormal hemoglobins) can also cause mild anemias.

A hemoglobin electropheresis can rule that out.

Another possibility is the bone marrow failure for some reason.

This should be ruled out.

Hence, you should consider seeing a specialist like hematologist for further work up.
I also had a B12 and folate, and they were normal. What tests would a hematologist run?

Mysticdoc :
Then the next possibilities like abnormal hemoglobins ( thalassemia trait for example) or bone marrow issues should be ruled out. Hemoglobin electropheresis, a peripheral blood smear to look for abnormal cell morphologies and a bone marrow examination if needed
The peripheral smear is normal, I doubt that the Hgb electrophoreis would show any abnormalities. Does a 11.4 Hgb warrant a bone marrow?

Mysticdoc :
It is not the number as per se, but the gradual decrease should be concerning. This does not warrant bone marrow right now. This can be observed for 6 months with repeat CBCs.
Would taking an iron pill be helpful?

Mysticdoc :
You can try iron pills. Also get your ferritin level checked. Try with vitamin C pills 500 mg daily.
Thanks, ***** ***** verified my thoughts. Are there tumors that would cause this?

Mysticdoc :
Multiple myeloma is one example. myelodisplastic syndrome. This causes change in bone marrow composition making red cell and other cell production ineffective.
Actually, my father died from multiple myeloma. My proteins have been normal.

Mysticdoc :
ok good. Most likely this is not concerning but you should be aware of this and if further change in numbers, then consult a hematologist.

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