Anaemia & Blood Problems

Anaemia means the blood carries less oxygen than it should, usually because the haemoglobin level is below the normal range. Haemoglobin is the protein inside red blood cells that carries oxygen from the lungs to the rest of the body, and a low level leaves the tissues short of oxygen. Anaemia is very common, often causes no symptoms in its early stages, and is usually first noticed on a routine complete blood count (CBC). Most cases are mild and treatable once the cause is found, but because the same blood test can also flag more serious problems, an abnormal result should always be properly evaluated rather than ignored or self-treated with supplements.

This service covers the full range of blood-related concerns seen in an Internal Medicine / General Physician practice — anaemia and low haemoglobin, iron deficiency and iron deficiency anaemia, vitamin B12 and folate deficiency, nutritional anaemia, the symptoms anaemia produces (fatigue, weakness and breathlessness), the different red-cell patterns (microcytic, macrocytic and normocytic anaemia), and the interpretation of abnormal blood counts and inflammatory markers (high and low white cell counts, high and low platelet counts, high ESR, high CRP and elevated ferritin). Where a blood problem overlaps with digestion, kidneys, fever, breathing or chronic inflammation, Dr. Nayak connects the care across the relevant services.

Common patient concerns

Most people come in for one of a few reasons: a routine blood report showing low haemoglobin or an abnormal blood count, persistent tiredness or breathlessness that turns out to be anaemia, a known deficiency that is not improving with supplements, or an isolated abnormal result such as a high white cell count, low platelets, raised ESR or CRP, or a high ferritin that needs explaining. Some are otherwise well and simply worried by a number on a report; others have symptoms that need tying to the result. Each of these is explored in its own page below.

Understanding anaemia

Anaemia is defined by haemoglobin below the normal range for age and sex — roughly below 13 g/dL in men and below 12 g/dL in women, with slightly different cut-offs in pregnancy and older age. It is not a disease in itself but a sign that something has reduced the number or oxygen-carrying capacity of red blood cells. The three questions that guide every anaemia assessment are: how low is it, what pattern do the red cells show (small, normal-sized or large), and what is causing the shortfall in production or the excess loss or breakdown. Answering these points the way to the right treatment.

Symptoms of low haemoglobin

• Tiredness and lack of energy, often worse on exertion.
• Breathlessness, especially with activity or, when severe, at rest.
• Light-headedness, dizziness or feeling faint.
• Palpitations — a fast or pounding heart.
• Pale skin, pale inner eyelids, palms or nail beds.
• Cold hands and feet.
• Headache, poor concentration or ringing in the ears in some people.

How noticeable these are depends on how low the haemoglobin has fallen and how quickly. A gradual drop over months is often tolerated with few symptoms, while a rapid fall is felt much more. The body partly compensates by raising the heart and breathing rate, which is why exertional breathlessness and palpitations are common early clues. See Fatigue Due to Anaemia, Weakness Due to Low Haemoglobin and Breathlessness Due to Anaemia for the symptom-focused pages.

Fatigue, weakness and breathlessness related to blood problems

Tiredness is the commonest symptom of anaemia, but fatigue has many other causes — poor sleep, thyroid disorders, diabetes, chronic illness, low mood and vitamin D deficiency among them — so anaemia is considered alongside these rather than assumed. Breathlessness from anaemia is usually worse with activity and improves as the haemoglobin rises; but breathlessness can also come from the heart or lungs, so when it is disproportionate or occurs at rest, those systems are assessed too. Dr. Nayak places the blood result in the context of the whole picture. See Fatigue, Weakness & General Symptoms and Respiratory & Breathing Problems.

Common causes of anaemia

• Iron deficiency — the commonest cause, from inadequate diet, poor absorption or blood loss (see Iron Deficiency Anaemia and Iron Deficiency).
• Blood loss — heavy periods, bleeding from the stomach or bowel, piles, ulcers or repeated blood donation.
• Vitamin B12 or folate deficiency — affecting red-cell production (see Vitamin B12 Deficiency and Folate Deficiency).
• Chronic disease — long-standing inflammation, kidney disease, thyroid or autoimmune disease (see Kidney Health).
• Reduced production — bone marrow causes, nutritional lack or early kidney disease.
• Increased breakdown — haemolytic anaemia, where red cells are destroyed faster than they are made.

Nutritional deficiencies

In India, the commonest cause of anaemia by far is nutritional iron deficiency, often compounded by vegetarian diets with limited absorbable iron, heavy menstrual loss, and repeated pregnancies. Vitamin B12 deficiency is also common, particularly in strict vegetarians and vegans, and folate deficiency can occur with a poor diet, pregnancy or certain medicines. Nutritional anaemia is largely preventable and reversible, but the deficiency must be confirmed and the cause addressed — not just the number corrected — or it simply returns. See Nutritional Anaemia.

Abnormal blood test results

A complete blood count reports haemoglobin, the red cell indices (MCV, MCH), the white blood cell count and its differential, and the platelet count. Each line can be high, low or normal, and each abnormality has its own set of causes. A single mildly abnormal value is often harmless or transient, but persistent, marked or combined abnormalities need evaluation. Inflammatory markers — ESR and CRP — are non-specific tests that, when raised, signal inflammation or tissue stress somewhere in the body and point towards further targeted testing rather than a diagnosis in themselves. See Abnormal Complete Blood Count (CBC), High ESR and High CRP.

Medical evaluation

Evaluation begins with the full blood report rather than a single number, and combines the story (diet, menstrual loss, bowel symptoms, weight change, fever, family history, medicines) with a physical examination. The red-cell pattern — microcytic (small), macrocytic (large) or normocytic (normal-sized) — narrows the causes and guides the next tests. The aim is to identify the cause before starting treatment, because giving iron or vitamins without knowing why the count is low can mask a more serious problem such as bowel bleeding.

Relevant blood investigations

• Complete blood count with red-cell indices (MCV, MCH, MCHC, RDW) and a peripheral smear.
• Iron studies — serum iron, ferritin, transferrin saturation and TIBC.
• Vitamin B12 and serum or red-cell folate.
• Reticulocyte count — to judge whether the marrow is responding.
• Inflammatory markers — ESR and CRP.
• Kidney function, thyroid function and blood sugar where relevant.
• Stool examination for hidden blood when blood loss is suspected.

Treatment and management approach

Treatment is cause-specific. Iron deficiency anaemia is treated with oral iron, given with vitamin C and away from tea, coffee and calcium, with the cause of the deficiency addressed at the same time; intravenous iron is used when oral iron is not tolerated, not absorbed, or when a faster rise is needed. Vitamin B12 deficiency is treated with B12, by injection when absorption is the problem, and folate deficiency with folate tablets. Anaemia of chronic disease is managed by treating the underlying condition, and kidney-related anaemia may need specific support. Self-prescribing high-dose iron or vitamins is discouraged, as excess iron can be harmful and can hide the real cause.

Monitoring and follow-up

Haemoglobin usually rises within two to three weeks of correct treatment, and iron stores (ferritin) take longer to refill — typically three to six months after the haemoglobin normalises. Treatment is continued until stores are replenished and the cause is controlled, with repeat blood tests to confirm the response and check it is holding. If the count does not improve as expected, the diagnosis and adherence are reviewed and further tests arranged. See Abnormal Test Results and Preventive Health & Health Check-ups.

Warning signs and when urgent medical evaluation is important

• Severe breathlessness, chest pain or fainting with a very low haemoglobin — emergency.
• Black stools or visible blood in the stool or vomit — possible serious bleeding, urgent.
• Rapid onset of marked paleness, weakness or a fast heart rate.
• High fever with a very low or very high white cell count — urgent.
• Unexplained bruising, bleeding gums or petechiae with a low platelet count — urgent.
• A haemoglobin that is falling rapidly on repeat testing.

In-clinic and teleconsultation

Consultations are available both in-clinic in Bhubaneswar and over teleconsultation. Review of an abnormal blood report, repeat-test planning and follow-up of a known deficiency often suit teleconsultation, while new symptoms, a markedly abnormal count, or suspected bleeding are best assessed in person with examination and tests. A flat ₹500 fee applies to either format. Use any “Book an appointment” button on this page to schedule your visit.