Low Hemoglobin: Symptoms in Women and Men and What They Indicate

Fatigue, a pale face, and "no energy even after the weekend" — these are the complaints that often bring hemoglobin to mind. Let's break down which signs are truly linked to its decrease and what a blood test shows.

What hemoglobin is and what level is considered low

Hemoglobin is an iron-rich protein that gives blood its red color and carries oxygen from the lungs to all organs. When hemoglobin and red blood cells decrease, tissues receive less oxygen — hypoxia develops.

Anemia is not a separate disease but a syndrome occurring in various conditions; it affects about a third of the world's population and is more common in women, especially pregnant women, as well as in children and older adults. Hemoglobin norms differ by sex and age, so one should look at their laboratory's reference values rather than a single number from the internet.

Separately, hydremia is distinguished — "dilution" of the blood, for example in pregnant women, when the liquid part of the blood increases but the cells and hemoglobin do not decrease.

Main symptoms of low hemoglobin

Anemia often proceeds unnoticed and is found incidentally in a test. When signs are present, they are related to a lack of oxygen:

• fatigue and lack of energy;
• shortness of breath with slight exertion;
• noticeable heartbeat;
• headache and dizziness;
• pallor of the skin and mucous membranes.

Less commonly there is noise or ringing in the ears, a strange taste of food, itchy skin, a sore tongue, hair loss, a craving to eat non-food items (paper, ice), difficulty swallowing, cracks in the corners of the mouth, spoon-shaped nails, restless legs. A person feels cold and irritable — such things are easily attributed to temperament or the weather.

Symptoms of low hemoglobin in women: specific features

Anemia is more common in women. The two most frequent causes are heavy menstruation and pregnancy: heavy menstruation is a common cause of iron-deficiency anemia. During pregnancy, deficiency is more often related to a lack of iron in the diet; in addition, pregnant women may have hydremia (pseudoanemia), in which the volume of the liquid part of the blood increases while the number of red blood cells and hemoglobin remains the same.

Why hemoglobin decreases

Three mechanisms: blood loss, insufficient production of red blood cells, and their accelerated destruction. The most common type is iron-deficiency anemia.

Causes: heavy menstruation, pregnancy, ulcers, polyps or colon cancer, hereditary diseases, a diet lacking iron, folic acid or vitamin B12, blood diseases, aplastic anemia, G6PD deficiency. Bleeding from the stomach and intestines is a common cause: it is caused by ibuprofen and aspirin, ulcers, inflammation of the intestines or esophagus, hemorrhoids, and less often tumors of the stomach and intestines. There are also other types — B12-deficiency, folate-deficiency, hemolytic, posthemorrhagic.

How low hemoglobin is diagnosed

The doctor asks about lifestyle and past illnesses, performs an examination, and usually orders a complete blood count: it shows the number of red blood cells and other blood cells, and no preparation is needed. If the cause is unclear, additional tests are added — a fecal immunochemical test for occult blood (FIT), tests for ferritin, vitamin B12 and folate, assessment of the color index (normal 0.86–1.1) and reticulocytes (0.5–2%); if necessary, the patient is referred to a specialist.

Possible consequences and when to see a doctor

Without treatment, anemia increases the risk of diseases and infections because iron deficiency affects immunity, and it can cause complications from the heart and lungs — tachycardia or heart failure. Pregnant women have a higher risk of complications before and after childbirth.

Low hemoglobin by itself is not a reason to call an ambulance. 103 or 112 — if signs of a life-threatening condition appear, such as a stroke or heart attack.

See a doctor routinely if fatigue and pallor are bothersome or anemia is suspected. The doctor evaluates the complaints, medical history, and test results.

This material is for reference and does not replace a doctor's consultation — if fatigue and pallor persist, discuss tests with your doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer