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Which diseases would be likely to cause a fairly rapid decline in hemoglobin count?

In this particular case, hemoglobin count went from 7.6 to 6.4 in 48 hours, despite 2 units of hemoglobin being administered (1 per day).

This seems to be well beyond a mere failure to produce hemoglobin, as hemoglobin decays slower than that. It seems more like a disease that is actively destroying hemoglobin cells. Which diseases would do that?

(Healthy 50 year old male patient, no medical issues prior to this except overweight (29BMI). Came in for shortness of breath, hemoglobin count 8.0 at admission.)

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  • Though not a disease, per se, one possibility is stomach ulcer, though this would present as black stool or vomiting of blood, which may also be black depending on how long it's been in the stomach.
    – BillDOe
    Aug 25, 2018 at 21:04
  • Inner bleedings might also be a reason...
    – Narusan
    Sep 7, 2018 at 14:30

1 Answer 1

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There could be different reasons which can explain this situation. They are all well presented in this page of the Mayo Clinic (https://www.mayoclinic.org/symptoms/low-hemoglobin/basics/causes/sym-20050760).

In short, those are the most common main causes:

  • Your body produces fewer red blood cells than usual
  • Your body destroys red blood cells faster than they can be produced
  • You experience blood loss

I don't think that here we can do differential diagnosis (also because we don't have the whole clinical history of the patient). In any case, in acute, it could be good to evaluate the third cause. It doesn't have to be an important hemorrhage, but also a bowel disease which leads to slow blood loss (but this won't answer to the important drop of hemoglobine). Or esophageal varices

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  • Good answer and thank you for providing reference. Another common consideration is hemodilution from high quantities of IV fluids, but that is an assumption made based on all 3 cell lines and only after excluding other more serious potential causes.
    – DoctorWhom
    Aug 26, 2018 at 18:02

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