Hemoglobin is a specialized protein found in the blood, concurrently carried by the red blood cells or erythrocytes. Because the red blood cells are responsible for the transport of oxygen throughout the body, it is essential that they can do their role.
In conditions wherein the hemoglobin levels are low, this would result in lower oxygen concentration in the blood and tissues thereby inhibiting the body from accomplishing normal physiology and processes.
Signs and Symptoms of Low Hemoglobin
Clinical manifestations of low hemoglobin levels include the following:
- body aches
- brittle nails
- chest pain
- episodes of dizziness or fainting
- feelings of generalized weakness
- tachycardia
- sore or swollen tongue
- headache
- irritability
- pale skin
- shortness of breath
- issues in concentrating or sleeping
- abnormal cravings, or the presence of pica to non-food items such as dirt, etc.
Causes of Low Hemoglobin
There are various factors that can affect the hemoglobin levels in the patient’s body, and they are classified according to the following:
- Low production of red blood cells. The body primarily produces both red and white blood cells in the bone marrow. However, due to some instances and illnesses, the production may be compromised thereby reducing the bone marrow’s capacity to produce enough red blood cell counts.
- The red blood cells are dying soon. Some patients have their bone marrow produce an adequate supply of red blood cells but due to discrepancies, break down faster than the body can replace damaged cells.
- Blood loss due to injury or illness. Iron is an essential micronutrient that aids in the formation of red blood cells. Any associated blood loss will result for iron levels to decrease. Women who experience low hemoglobin levels would oftentimes have depressed iron levels in relation to menstruation. Bleeding ulcers in the gut would also cause iron and hemoglobin levels to depreciate.
- Problems in absorbing iron. Since iron is a crucial component in the production of red blood cells, systemic absorption issues would eventually result to low hemoglobin levels.
- Inadequate amount of essential nutrients. Besides iron, vitamin B12 (i.e., cobalamin) and vitamin B9 (i.e., folic acid) are also crucial micronutrients in the production of red blood cells.
Risk Factors to Low Hemoglobin
Certain conditions or risk factors predisposes a patient to develop low hemoglobin levels. As the body develops issues in the production of red blood cells, so will the hemoglobin levels start to plummet. These conditions that affect the red blood cell production are as follows:
- Lymphoma. Lymphoma is the cancer of the lymphatic system. Abnormal proliferation of lymphoma cells in the lymphatic system that spills into the bone marrow can crowd out inherent erythrocytes, thereby lowering its levels.
- Leukemia. The cancer of the blood and bone marrow is coined as leukemia. Having deviations in this tissue would cause the proliferation of leukemia cells thereby reducing erythrocytes levels that the body creates.
- Anemia. Anemia is synonymous to low hemoglobin levels. There are various forms of this condition and are the following:
- Aplastic anemia – This type of anemia is characterized by inadequate blood cell production due to problems of the stem cells found in the bone marrow.
- Pernicious anemia – This type of anemia is characterized by the inefficiency of the body to absorb vitamin B12 due to a pre-existing autoimmune disease.
- Multiple Myeloma. In this condition, the body produces excess and deviant plasma cells that overwhelms and dislodges red blood cells.
- Myelodysplastic syndromes. In this condition, the blood cells develop abnormally due to issues in the body’s blood stem cells producing diseased cells.
- Chronic kidney disease. Due to decreasing erythropoietin levels, the hormone stimulating erythrocyte production, red blood cell production is compromised that will lead to low hemoglobin levels.
- Antiretroviral medications. Antiretroviral medications are potent enough that it not only attacks the latent viral infection but also is possible to destroy the patient’s bone marrow, thereby affecting erythrocyte production.
- Chemotherapy. Chemotherapy reduces the number of fast-producing cells in the body, both healthy and aberrant. It affects the bone marrow, which is the source of new blood cells, thereby inciting low hemoglobin levels.
In addition, there are also additional factors that affect the lifespan of the erythrocytes that will lead to low hemoglobin levels. They are:
- Splenomegaly. The spleen is the organ that filters the blood as it circulates in the body. Due to its trapping mechanism, the spleen will grow resulting in splenomegaly and reduced lifespan.
- Sickle cell anemia. In sickle cell anemia, some of the red blood cells develop into crescent-like shapes thereby reducing its use and compromising its overall function.
- Thalassemia. This genetic condition prohibits the body from making hemoglobin and erythrocytes.
On top of this, certain people are prone to develop low hemoglobin levels due to:
- Age. Infants aged 6 to 12 months are prone due to the immaturity of their bodies. Teens are also prone due to the sudden growth spurt and poor food choices. Elder adults (65 years old and above) are prone due to aging bodies.
- Children with lead in their blood. The presence of lead in the blood hinders the bodies’ ability to manufacture hemoglobin.
- Pregnant. Pregnant women are prone due to sudden body changes and the development of the unborn fetus in the womb.
- Vegetarians or vegans. People how have adapted the vegetarian or vegan lifestyle are prone to low hemoglobin levels due to the inadequacy of their diets to supply the required iron and vitamin B complex.
Complications of Low Hemoglobin
Complications of low hemoglobin levels may lead to various health issues such as:
- Extreme Fatigue. Patients with severe anemia will hinder them from performing their activities of daily living due to low levels of available oxygen.
- Pregnancy complications. Expecting mothers diagnosed with folate deficiency anemia are prone to develop complications such as premature birth.
- Heart problems. Arrhythmia may develop in patients with low hemoglobin levels as the body’s compensatory mechanism to supply oxygen to the various tissues. If left chronically, may develop to heart enlargement, and consequently may develop further as heart failure.
- Death. Instances of inherited anemias, such as sickle cell anemia, can cause life-threatening conditions thereby increasing the mortality risks.
Diagnosis of Low Hemoglobin
Diagnosing low hemoglobin levels and anemia would include a variety of techniques, some of which are:
- Medical and Family history. Assessing for a complete history would help the caregiver to evaluate for risk factors that would precipitate a patient to develop or increase his risk of low hemoglobin levels.
- Comprehensive physical exam. The care provider rendering a thorough and comprehensive body systems check will aid in supporting an anemia diagnosis.
- Complete blood count (CBC). The CBC is a laboratory exam done to the patient’s blood wherein the number of blood cells are counted from an extracted blood sample. In a CBC, the patient’s erythrocyte, leukocyte, thrombocytes, and other cellular components are calculated. Focus is given to erythrocyte levels, hematocrit concentrations and hemoglobin count to establish an anemia diagnosis. The typical healthy adult hematocrit levels are 38.3% to 48.6% for men and 35.5% to 44.9% for women. Normal hemoglobin values for men are between 13.2 to 16.6 g/dL and 11.6 to 15 g/dL for women. Normal erythrocyte counts for men is between 4.0 to 5.9 x 10*12/L and 3.8 to 5.2 x 10*12/L for women.
- Hemoglobin electrophoresis. This procedure may be done to the patient’s blood to evaluate the different kinds of hemoglobin present in his red blood cells.
- Bone marrow aspiration and analysis. In some instances, wherein there are issues with the patient’s red blood cells itself, the physician may do bone marrow aspiration. Evaluating the patient’s bone marrow would lead to clues to the patient’s blood cell morphology to have a conclusive diagnosis, such as a blood cancer diagnosis (i.e., Leukemia), etc.
Treatment for Low Hemoglobin
Treatment protocols and approaches for patients with low hemoglobin include a variety of techniques such as:
- Iron supplements. These may be prescribed by physicians to be taken orally at least twice a day. Taking note of possible side effects such as vomiting, or diarrhea is warranted so that dosages or types of supplementations may be adjusted accordingly.
- Intravenous Iron therapy. Iron infusion via the intravenous route may be given for patients with severe cases requiring faster and efficient iron supplementation. Patients with chronic conditions such as Celiac disease or renal issues are the typical patients given this form of therapy.
- Red blood cell infusion. Blood transfusions of packed RBC’s is an even faster way of treating low hemoglobin values to raise the red blood cell count and iron of severely anemic patients.
- Surgery. Some patients suffering from low hemoglobin may have occult bleeding and would necessitate surgical intervention to address. An upper endoscopy (EGD) or colonoscopy may be utilized to visualize the source of the bleeding and control accordingly.
- Dietary supplementation. Instructing the patient to take foods rich in iron such as beans and legumes, fish, meat, leafy greens, poultry, and tofu may be helpful in increasing iron levels that will eventually raise hemoglobin levels. Teaching the patient to consume foods high in vitamin C, such as citruses, can enhance iron absorption. The patient with low hemoglobin and iron levels would need to take around 150 to 200 mg of supplemental iron daily to achieve adequate values.
Nursing Diagnosis for Low Hemoglobin
Nursing Care Plan for Low Hemoglobin 1
Nursing Diagnosis: Fatigue related to low hemoglobin secondary to iron deficiency anemia as evidenced by dyspnea, inability to maintain usual level of physical activity, increased rest requirements, and patient’s report of fatigue and lack of energy.
Desired Outcomes:
- The patient will be able to express understanding about the use of energy conservation principles and techniques.
- The patient will be able to express decreased fatigue, as evidenced by increased energy and ability to do desired activities and tasks.
| Nursing Interventions for Low Hemoglobin | Rationale |
| 1. Check the cause and the level of the patient’s fatigue. | Hypoxia from normocytic anemia and other medical problems and situations may cause fatigue in the patient and may compromise the patient’s activity tolerance. |
| 2. Evaluate the patient’s ability to do activities of daily living as well as the demands of daily living. | The nurse should evaluate the patient’s ability to participate, perform self-care, and do his or her responsibilities in the family and society because this may be affected by fatigue. |
| 3. Check and monitor the hemoglobin, hematocrit, RBC counts, and reticulocyte levels. | It is important to check and evaluate the laboratory values to decrease the risk of having life-threatening situations. When the patient’s RBC level is decreased it will decrease the oxygen-carrying capacity of the blood. |
| 4. Advise and assist the patient when planning the schedule for his or her daily activities and stress the importance of frequent rest periods. | A balance period of rest is important to help the patient have a complete desired activity without increasing the patient’s fatigue levels. |
| 5. Instruct and teach the patient about the energy-conservation techniques that he or she may use. | Energy conservation techniques may help the patient learn new skills and priorities for the desired activities of daily living. The patient should be taught about time management and organization that will help the patient conserve and reduce fatigue. |
Nursing Care Plan for Low Hemoglobin 2
Nursing Diagnosis: Deficient Knowledge related to low hemoglobin level secondary to aplastic anemia evidenced by inaccurate follow-through of instructions, questioning members of the health care team, and verbalization of inaccurate information.
Desired Outcomes:
- The patient will express understanding about his or her condition and possible causative factors.
- The patient and the family members will express knowledge about the patient’s treatment plans.
| Nursing Interventions for Low Hemoglobin | Rationale |
| 1. Ask the patient and the family members about their knowledge about the condition, the disease process, possible causative factors, and treatment. | Assessing the patient’s current knowledge and perceptions about the condition will help the nurse in facilitating the plan of individualized teaching. The nurse should use words and languages that the patient and the family members will easily understand. |
| 2. Enlighten the patient about the importance of the diagnostic procedures including the complete blood count, bone marrow aspiration, and the possible referral to a hematologist. | Diagnostic procedures are important to help in diagnosing the type of anemia which will be based on the changes in the RBC levels and the findings in the bone marrow aspiration. |
| 3. Explain the need to avoid known risk factors. | Alcoholism, exposure to toxic chemicals, dietary problems, and the use of medication that may affect red blood cell production are some of the causative factors of low hemoglobin levels. The nurse should instruct and explain that these risk factors should be avoided. |
| 4. Advise and educate the patient to eat foods rich in iron, folic acid, and vitamin B12. | It is important to instruct the patient to eat foods that contain essential nutrients which are needed to promote RBC formation. |
| 5. Instruct the patient and the family members about the replacement therapy with folic acid and iron. | The severity of anemia should be considered before administering medications. The nurse should instruct the patient to take supplements with meals to prevent a gastric upset. |
Nursing Care Plan for Low Hemoglobin 3
Nursing Diagnosis: Risk for Infection related to low hemoglobin secondary to pernicious anemia.
Desired Outcomes:
- The patient will show a reduced risk of infection as evidenced by the absence of fever, normal white blood cell count, and normal vital signs.
- The patient will verbalize knowledge about the implementation of the preventive measures such as doing hand washing.
| Nursing Interventions for Low Hemoglobin | Rationale |
| 1. Check for the presence of local or systemic signs of infection including fever, chills, swelling, pain, and body malaise. | Opportunistic infections may occur in patients with a weakened immune system. Monitoring the presence of systemic infections will help in preventing the risk of complications. |
| 2. Check and monitor the patient’s white blood cell count (WBC). | Monitoring the WBC is important because changes in the result of WBC will help in diagnosing infections. White blood cells are part of the person’s immune system because white blood cells help in fighting infection and other diseases. |
| 3. Advise the patient to refrain from eating raw fruits, raw vegetables, and uncooked meat. | Raw food, raw vegetables, and uncooked meat can harbor bacteria. The patient should be advised a low-bacterial diet to protect him or her from being exposed to pathogens. |
| 4. Explain to the patient the importance of proper daily hygiene, mouth care, and perineal care. | Proper hygiene, mouth care, and perineal hygiene are important to avoid skin breakdown and lessen the risk of infection. |
| 5. Advise the patient and the visitors to do proper hand washing. | Proper handwashing is important to prevent infection, and it can also prevent the spread of germs. |
| 6. For hospitalized patients, the nurse should provide a private room for protective isolation. | The environment is important to patients with low neutrophil counts and protective isolation precautions should be practiced. Placing the patient in a private room is needed and advise the people who have contact with the patient to use masks, gowns, and gloves to avoid the risk of infection. |
Nursing Care Plan for Low Hemoglobin 4
Nursing Diagnosis: Risk for Bleeding related to low hemoglobin and bone marrow malfunction secondary to aplastic anemia.
Desired Outcomes:
- The patient will show decreased risk for bleeding as evidenced by adequate levels of the platelet.
- The patient will be free from bruises and petechiae.
| Nursing Interventions for Low Hemoglobin | Rationale |
| 1. Check the patient’s skin for the presence of bruises and petechiae. | The presence of bruises and petechiae usually happens when the patient’s platelet counts drop. Low levels of platelet may occur because of the bone marrow. |
| 2. Ask the patient if he or she is experiencing frank bleeding from the nose, gums, vagina, and gastrointestinal tract. | The nurse should explain to the patient that these sites are the most common site for bleeding. Early assessment of these symptoms will help the nurse in facilitating immediate treatment. |
| 3. Check and monitor the patient platelet count and check for the presence of thrombocytopenia. | A patient with thrombocytopenia or low platelet count is caused by the patient’s bone marrow deficiencies that happen because of nutritional deficiencies, drugs, viral causes, or aplastic anemia. A decreased level of a patient’s platelet count will increase his or her risk of bleeding. |
| 4. Observe the patient’s stool and urine for the presence of occult blood. | Testing the stool and the urine for the presence of occult blood helps in identifying the site of bleeding. |
| 5. Instruct and teach the patient about the bleeding precautions. | If the patient’s platelet counts drop, bleeding precautions should be advised to the patient to avoid spontaneous bleeding. Precautionary measures for bleeding should be taught to the patient these measures include: Instruct the patient to avoid using a razorUse a toothbrush that is soft when brushing the teethRectal procedures should be avoided such as suppositories, enemas, and temperature taking in the patient’s rectum |
Nursing Care Plan for Low Hemoglobin 5
Nursing Diagnosis: Activity Intolerance related to low hemoglobin and imbalance between oxygen supply and demand secondary to pernicious anemia.
Desired Outcomes:
- The patient will express understanding of the factors that affect activity tolerance.
- The patient will express his or her ability to perform activities of daily living and will be able to use energy conservation techniques.
- The patient will express understanding about the different methods to decrease activity intolerance.
| Nursing Interventions for Low Hemoglobin | Rationale |
| 1. Ask the patient about his or her manifestation of activity intolerance and ask him or her to rate perceived exertion on a scale of 0-10. | A patient who is experiencing signs of activity intolerance and reduced tissue oxygenation may show symptoms including dyspnea on exertion, headaches, dizziness, and palpitation which should be monitored. |
| 2. Check and monitor the patient’s oxygen saturation level and encourage deep breathing exercises and provide oxygen as prescribed by the physician. | Oxygen saturation should be checked and monitored to assess the level of oxygen and carbon dioxide in the patient’s blood. Activity intolerance and decreased oxygen saturation are common in patients with low hemoglobin levels. |
| 3. Encourage the patient to verbalize feelings about his or her limitations. | Verbalization of feelings will help the patient to cope with his or her condition because having activity intolerance is physically and emotionally difficult for the patient. |
| 4. Advice the patient to perform a gradual increase of activities and range of motion exercises as tolerated by the patient. | This will develop the patient’s endurance and will help prevent complications due to prolonged bed rest. Range of motion ROM) exercises is important to patients with activity intolerance because ROM exercise will strengthen the muscle and joints of the patient. |
| 5. Record and document the patient’s response to the activities. | Monitoring the patient’s response to the activities and interventions will serve as a guide for the optimal progression of the activity and condition. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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