Today this chick came into the lab with a hemoglobin of 40g/L I think due to iron deficieny anemia (ferritin <1, severe microcytic hypochromic cells, RBC count 3.2x10^12)
She WALKED in. How is this possible? I remember from school that they told me that some people with chronic anemia can ‘adapt’ to the low O2 available to them, but how? How can your brain cope with getting 1/3 of the O2 it normally gets?
If they hooked me up to 2 IVs, one sucking my blood out and the other putting volume expanders until my hemoglobin was at 40g/L I assume I would at least be unconscious. (my Hgb is usually around 160g/L). Right? Why would I be unconscious and she can walk around and do stuff? I imagine she feels like shit, but still.
And how can someone manage to avoid iron so thoroughly for so long to get this way in the first place?
The lowest hemoglobin I saw on a walking, talking (albeit slowly) person was 2.5!
These people get that way very slowly. In the abovementioned case, it was in a chronic alcoholic who suppressed his bone marrow.
When the hemoglobin drops slowly, the body adapts. Had a normal person dropped from a nice level of 14 to 10 suddenly, they’d die from volume loss. But gradually the body compensates for slowly falling hemoglobin, by increasing plasma volume, lowering metabolism, and by just moving slowly!
So the brain and body is not really getting 1/3 of the Oxygen needed. It’s getting the same amount, the body just has virtually no reserve.
QtM, MD
QtM Thanks for the info. 25g/L!??! :eek:
We had a woman come in for transfusions about every month or so. She’d say she was feeling a little “run down”, and her H/H would be typically 4.5/14. She had breast cancer that had metasticized to her bone marrow, and it just could keep up. Her RBC loss was slow enough that she could compensate. Another time I assisted our lab medical director with a bone marrow biopsy. This was on a woman who was a little loopy, and suspicious of doctors. She had some sort of myeloproliferative disease that had gone untreated for some time. She was the color of death, and had an HGB of 3 or perhaps a little less. I crossmatched four units for her, and thought that she’d feel like she could fly to the moon after the first unit. Again, this woman’s loss was slow enough that she was able to compensate to levels far below what others would not be able to survive.
Vlad/Igor
Shocking, isn’t it? In my line of work (kids w/ cancer), we see very low hemoglobins all the time. But one time I took care of a kid with a Hgb of 2.3! Still talking, awake, alert. Not walking…he was too sick. He did go to ICU quickly, though. I’m constantly amazed at what the human body can adapt to.
Lorie, RN
A lot of staring transfixed at nothing.