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Done CBC test, low hemoglobin level. What is causing my hemoglobin level to drop?

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Practicing since : 2002
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Please refer to my CBC test report below which was taken on 19-Feb-2012:

Haemoglobin: 5.6 gms/dl
Erythrocyte Count: 2.37 million per c.u. mm
Leucocyte Count: 6510 per cu. mm

[B][U]R.B.C. Indices[/U][/B]
P.C.V.: 19%
M.C.V.: 82 femtolitres
M.C.H.: 24 pico-grams
M.C.H.C.: 29%
R.D.W. - S.D.: 44.2 fl.
R.D.W. - C.V.: 14.96

[B][U]W.B.C. differential count[/U][/B]
Neutrophils: 61%
Lymphocytes: 33%
Eosinophils: 2%
Monocytes: 4%
Basophils: 0%
Platelet Count: 0000 per cu. mm

Method: Fully automated Cell counter - CELLENIUM - 19


I am a male. No matter whatever I am trying to improve my haemogloblin, it is not working. I have all sorts of iron XXXXXXX food - apples, papayas, bananas, gourd juice, almonds, peanuts, spinach, beetroots, carrots, wheat, soyabeans, chick peas etc. as well as Vitamin C XXXXXXX food - goose berries, tomatoes and oral Vitamin B12 & vitamin C supplements. I am also taking iron shots (Vitcofol) every alternate day. As on the report date, I had taken 8 of them.
In December 2011, after profuse bleeding from stools for 3 days due to haemorrhoids my haemoglobin had gone down to 3.9 gms/dl. After getting blood transfusion it got restored to 7.1 gms/dl. Later on after having iron XXXXXXX food and oral iron supplements for 2 weeks it reached 7.9 gms/dl in January 2012. After one month in February, it suddenly dropped to 5.7 gms/dl, which I thought had happened due to intermittant bleeding from my stools during that period. I immeditately started taking iron shots after that and in the next week it got restored to 6 gms/dl. However, in the following week it again dropped to 5.6 gms/dl, although I had very little bleeding, only 2 times (10 to 20 drops each time). However strangely enough, the platelet count increased from 0000 per cu. mm in the previous week to 0000 per cu. mm (now), which I understand that my blood plasma has increased by 33% and my Erythrocyte Count reduced marginally from 2.38 million per cu. mm to 2.37 million per cu. mm. What is causing my haemoglobin level to drop? If it were due to bleeding haemorrhoids, the blood plasma also should have reduced. Please advise.
Posted Fri, 27 Apr 2012 in Blood Disorders
Answered by Dr. Robert Galamaga 8 hours later
Hello and thank you for submitting your question.

Your question is a good one and I will work on providing you with some good information and recommendations regarding what is going on.

I have to say that I really suspect that there is some additional gastrointestinal bleeding going on. The fact that your hemoglobin remains low is the reason why I think this is the case. It appears that your bone marrow is generating sales including white blood cells and platelets as well as the red blood cells but for some reason you remain significantly anemic.

I have a few recommendations at this point for you. The first recommendation would be to have your iron levels evaluated. This includes checking AC room iron level as well as total iron binding capacity and ferritin level. The ferritin level reflects your total body iron storage level. If the ferritin is significantly low you may need additional iron infusions.

In addition I believe you need to visit with a gastroenterologist to consider doing another colonoscopy and upper endoscopy. In addition it may be beneficial for you to have a capsule endoscopy performed to make sure that there is no minor bleeding going on in your small intestine.

It looks like you're doing everything that you should be doing in the terms of adequate diet in helping to maintain your iron levels. In addition I think it would be important that a pathologist reviews your blood cells under the microscope to make sure that there are no abnormalities in the red blood cells and that there is no sign that there is destruction of your red blood cells somewhere in your body such as your spleen.

I thank you again for submitting your question. I can appreciate that you are dealing with a very stressful situation and I hope my answer has help you with some good considerations. If you have any additional concerns I would be happy to address them.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Done CBC test, low hemoglobin level. What is causing my hemoglobin level to drop? 2 hours later
Dear Doctor,

Thanks a lot for the excellent answer!

Can a hematogist help me with checking AC room iron level, total iron binding capacity and ferritin level as well as checking for abnormalities in the red blood cells? If not, whom should I consult for checking them? Is there any type of specialist doctor who could check all of them?
Answered by Dr. Robert Galamaga 7 hours later
Thank you for your follow-up question.

I really think that the best physician for you to see at this point would be a hematologist. As hematologists we are skilled in the ability to look at blood cells under the microscope. If there are additional concerns the hematologist may have a pathologist review the slide as well. Hematologists are also very good at serving as detectives in trying to find out why blood counts are low such as the case you are dealing with.

Thank you again for sharing your health concern with me. I hope you found my responses to be adequate. If you have any additional concerns we are here to help.


Dr. Robert
Above answer was peer-reviewed by
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