my 99 year old Mom has a hemoglben count of 6.5, she is in assited living, she is not having any problems breathing or any other signs of stress, she is on high dose of iron is the anything else she can take besides having a transfusion?
There are lots of reasons to NOT transfuse. Each ER has their own protocol so please don't make blanket statements based on nothing.
I'm going to start with the obligatory: You definitely need to talk to a physician if you haven't. She should be seeing a hematologist.
I am 35 and my HGB is routinely < 6. I prefer not to transfuse. II take care of a 25 year old in full renal failure and anemia is one of the more common side effects of having no functioning kidneys. I am married to a celiac, and that condition comes with anemia issues as well. Bunch of pasty white folks roaming around this place. :)
It would help to know why she can't/won't transfuse, but realistically at her age if she is feeling no ill effects or major issues it might be ok to leave it be. Two of the main risks are lack of sufficient blood to the organs, resulting in organ failure. That takes some time to occur, and bleeding to death from injury. With levels like hers if she has a moderate accident the blood loss could very well be fatal.
I know you said she is on high doses of iron, but that doesn't tell me much. What KIND of iron? Elemental or not? Is she being infused as well? Does she have any GI issue? If she is taking iron pills or supplements but has a condition or issue that messes with absorption it's pointless. You may as well throw the pill directly in the toilet and flush.
My advice is get her to a hematologist. Medicare/medicaid should cover it with no drama. Nobody can really give you an useful list of options without knowing a little more about the cause of the anemia and the conditions that affect it. Hematologists are well versed in the "I don't want to transfuse" crowd, If there is another workable option, thats the Dr that will know. Don't trust a general physician with anemia treatment if you don't absolutely HAVE to. I it nutrition based? Is it coming from some kind of organ failure you have to know the cause. Once you have that you can get an idea of what CAN be done, what will work best for her and what the side effects and risk are. She is not symptomatic now, and to keep it that way, get with the Dr.and find out what the root cause is.
There are non transfusion options. Hormone therapies (called ESA's), supplements, infusions. You have options. Generally speaking its best to have a blood transfusion first because it will immediately bump her hemoglobin up. Once you get it up there you can rely on the supplemental things to KEEP it up. One maybe two units of blood will put her back around a "normal" HGB. Once you have her on solid footing you use the supplements and other non transfusion options to keep it up.
I know I wrote a book but anemia is a lot more complicated than give her a unit and call it done. If she is on high doses of oral iron and there isn't improvement, you need to move to the next level of care because it's not absorbing. If it's not absorbing already, its probably not going to.
I wish you both well and hope you get it sorted for her. Symptomatic or not the slow moving drowsy slug that anemia turns you into gets old FAST. Definitely hope you find a swift answer to get her feeling a little better quickly.
Orphicdragon provided excellent advice. The reason, or etiology for the problem must be established. I had such low numbers and functioned quite well. The cause turned out to be a slow bleed that was eventually surgically recitfied. 99 is not that old. My "little one" is 108 years old going on 109.
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