Brief Answer:
Please find reasons for no rise in hemoglobin given below

Detailed Answer:
Hi XXXX XXXXXXX
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

The normal hemoglobin range is 12.1 to 15.1 gm/ dL in an adult female. Your mother had slightly low hemoglobin before the procedure and after the angioplasty it is 7.5 to 8 gm/ dL. This means she might have had little bleeding and this was compensated for by infusing 3 packs of blood transfusion. Each pack of RBCs should rise the level of hemoglobin by 1 gm/ dL.

The possibilities for no significant increase in hemoglobin level after transfusion are the following:

1. Increased blood volume due to infusion of crystalloid or colloid solutions.

This can happen if she was given a lot of fluids during and after the procedure and the rise in hemoglobin level was a false value due to this.

2. Incomplete transfusion of RBC

This is ruled out as your doctors have confirmed transfusion of 3 units RBCs.

3. Ongoing bleeding

There is no major complication arising due to the procedure as CT scan and ultrasound shows no leakages at puncture site or elsewhere.

4. Hemolysis A hemolytic transfusion reaction should be considered in this case.

This can be known by discussing with your doctor and doing tests to know increased destruction of red blood cells after transfusion.

5. Transfusion of RBC units near expiry date. The post-transfusion survival of RBC decreases with storage time.

The usual lifespan of natural red blood cells circulating in the body is 120 days whereas that of transfused RBCs is about 50–60 days and can be significantly shorter in the presence of factors reducing their survival. This can cause no significant response to hemoglobin level after transfusion.

6. If your mother is has a higher body mass index and is well built then the rise in hemoglobin will be less post transfusion.

It will help to do repeat check of her hemoglobin by giving blood sample in a different laboratory and also doing a peripheral blood smear to know if she has anemia. Please get her treated for anemia and give her healthy nutritious food and supplements.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please find diabetes healthy diet details given below

Detailed Answer:
Hiy XXXX XXXXXXX
Thanks for writing back with an update.

Your mother needs a well balanced nutritious diet. As she is having diabetes for many years and I hope her sugar level is under control, it is important for her to get the right diet.

Special XXXXXXX diet for diabetes can be found using the following link
http://www.diabetesindia.com/diabetes/diet_chart.htm

For an elderly woman the daily calorie intake requirement might be 1500 to 1800 kcal and you will find vegetarian and non vegetarian meal choices in the above website.

Please also give her supplement of iron and folic acid tablets and these are found in all medical stores. Also, if she is taking oral tablets for diabetes like metformin then it is important to give her Vitamin B complex (including B 12) supplement daily.

Also please have her kidneys, eyes and nerves checked at least once every year as it is required in every patient having diabetes. Doing HbA1C test once every 3 months will give a better information of her sugar control.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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