6 ms·

A hemoglobin for 4-5 is anemia - the definition of anemia is low hemoglobin concentration. If your wife had hemoglobin that low, then she was correctly diagnose

A hemoglobin for 4-5 is anemia - the definition of anemia is low hemoglobin concentration. If your wife had hemoglobin that low, then she was correctly diagnosed with anemia. It is a bit odd though the apparent coinfection with multiple tick borne illnesses from different species of ticks - A lyme and ehrlichiosis coinfection is not surprising, but rocky mountain spotted fever is a very different illness, often more acute in presentation with distinctive signs and symptoms - but coinfection with the other two would be quite rare. Also, those specific tick illnesses listed are unlikely to cause that profound of an anemia by themselves, so there's probably some other pathology going on - the tick borne infection may only be a trigger. Any relatively young person that is otherwise healthy (no near end state kidney disease) should definitely get referral to a hematologist for hemoglobin of 4-5 if it isn't something blindingly obvious like blood loss.

DantesKite 4y ago
> If your wife had hemoglobin that low, then she was correctly diagnosed with anemia. That seems like a somewhat myopic perspective. Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness. A more accurate and helpful diagnosis would probably be something like "Babesiosis"——anemia caused by ticks infected with a microbe that destroys red blood cells especially considering the multiple cofactors at play. Or whatever it was that specifically caused the anemia; the parent comment didn't say.
- danachow 4y ago
  Dude, I'm just addressing this: "So things that can look like anemia can be other things! Case in point, my wife was misdiagnosed for months with Anemia." Which is a bit of a confused statement. > Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness. No, that's a pretty shit analogy and completely wrong. First, because chemotherapy doesn't cause "male pattern baldness" - the mechanisms aren't the same. So that's just wrong - while someone with a hemoglobin of 4 has anemia, whatever the underlying cause may be - it isn't a look alike - it is. Second, diagnosing Alopecia (secondary to chemotherapy) is a perfectly reasonable diagnosis. Because it is something that doctors do manage with specific things separately from the chemotherapy and other cancer treatment, eg wigs, scalp cooling. People can have more than one relevant diagnosis that they are treated for and are interrelated. For instance, if someone has anemia that is due to something like a GI bleed, they have both a GI bleed and anemia. If their hemoglobin is less than 7 you will likely treat that anemia with a blood transfusion independent of what you're doing to manage the GI bleed. GI bleed, iron deficiency, malabsorption, microcytic anemia are all diagnoses - they may be all interrelated. > A more accurate and helpful diagnosis would probably be something like "Babesiosis"--anemia caused by ticks But babesiosis is not anemia. It often occurs with it, but the diagnostic criteria for babesiosis is blood smear or PCR. If someone has a smear positive for babesia then they have babesiosis regardless of their Hgb/Hct. And notably they listed a bunch of tick borne illnesses listed, babesiosis was not among them.
  - Pigalowda 4y ago
    - danachow 4y ago
      > I’m sure you’re here to rub your reflex hammer in our ignorant little pig faces. I do realize there are a lot of crappy doctors out there, but about the person putting a reflex hammer in your face -- are you sure that was an actual doctor? To your other point, while I often realize the futility of responding to the direct commenter, this is a public forum so maybe others can get some information or entertainment, whatever might be.
      - Pigalowda 4y ago
      - haldujai 4y ago
        As a physician I am in complete agreement with danachow’s statements. A hemoglobin of 4 must be corrected irrespective of the underlying etiology. Furthermore, I am also in complete agreement that such a patient without obvious source for anemia requires a hematology consultation. That may be the only error that happened here. I would greatly welcome your rationale as to how we can safely discharge a symptomatic patient with a Hgb of 4 as this directly contradicts all of my medical training. In fact, I would lose my license if I ever did that. If you happen to know information about anemia I do not, please provide your rationale.
        com2kid 4y ago
        I've gone into the doctor with a BP of 160/90 and a headache that had been with me for 3 days. After asking some scary questions and ruling out that I wasn't going to die then and there, I was sent on my way and told good luck. I figured out myself that the problem was a potassium deficiency. I hadn't eaten any leafy greens in a week or two (lots of veggies, just none that had significant levels of potassium) and I don't normally eat any processed food. A couple handfuls of baby spinach later and my headache was gone. A lack of effort in diagnosis is the norm, not the exception. I have plenty of other stories! As does damn nearly every one else. Computer techs don't bother diagnosing PC problems and just prescribe a reboot. Many Doctors seem to have the same attitude, but for the patient things are a bit more personal.
- medymed 4y ago
  Right idea generally but in that scenario it would be like making a diagnosis of alopecia which just means hair loss. In any case some diagnoses don’t have clear explanations or subdivisions for decades or centuries until explanatory medical science catches up with the descriptive diagnoses like anemia or alopecia.
  - deleted 4y ago
    [deleted]
code_duck 4y ago
The difference is actually finding the root cause or just diagnosing what’s essentially a symptom as if it’s unexplained or isolated (idiopathic, I think is the term?). My mother was diagnosed with anemia, and received many recommendations ranging from not drinking tea to getting a hysterectomy (which was done, in her mid 40s). It turned out she wasn’t absorbing iron due to Celiac disease. Treating the anemia as if it was an isolated condition wasn’t helpful at all since she needed to address the root cause, Celiac.
- haldujai 4y ago
  “Anemia” isn’t really a diagnosis. Your mother had a microcytic anemia (a broad class based on lab results), of which there are several types including iron deficiency anemia. Next, there are multiple causes of iron deficiency anemia of which celiac disease is one of them. You would never diagnose a patient with “anemia” and stop there. Further work up for the etiology is mandatory and endoscopy is commonly performed. There is no such thing in modern medicine as “just treating anemia” unless you know the cause and the only treatment is transfusions.
  - DangitBobby 4y ago
    > You would never diagnose a patient with “anemia” and stop there. I kind of doubt that. In my experience, the treatment for chronic heartburn is to throw meds at it to stop the symptoms. After an upper endoscopy, no attempt at root cause was ever made.
    - haldujai 4y ago
      As much as you doubt that based on your anecdotal experience (addressed below), I’ve respectfully spent the past 9 years practicing medicine in 16 different hospitals across three countries and feel I am in a more appropriate position to comment on the medical standard of care. I can say with absolute confidence at none of the places I’ve worked at would a doctor leave a patient with a diagnosis of anemia as this is malpractice. Are there physicians in some hospitals who practice negligently? Sure, but there are also pilots who show up drunk to work and engineers who are negligent. That doesn’t mean the entire profession has a “problem”. Anemia is not heartburn. Anemia can be life threatening. As an analogy for the tech world. Anemia is a server crash. Heartburn is a warning in the server logs. You may decide the warning is not worth fixing / may result in new bugs (aka complication). When a server crashes step 1 is to get it back online (transfuse to a safe hemoglobin target). Step 2 is find out why the server crashed (why is this patient anemic, which is a sign/symptom and not a diagnosis). Just as a computer engineer would never say “I’m not sure why but let’s just keep restarting every time it crashes”, a doctor would not say “I’m not sure why you’re anemic” unless there was an extensive negative workup and the patient normalized therefore no longer requiring treatment. There is no situation where a physician just keeps transfusing an anemic patient without figuring out why. This is not only expensive, but transfusions carry risks and with repeated transfusions some risks increase. This is not a medically accepted management plan anywhere and the hospital / blood bank would quickly intervene if a non-hematologist was serially transfusing a patient as this is outside their scope. In your example: Your negative endoscopy excluded H. pylori, gastric malignancy, peptic ulcer disease, and a hiatal hernia. Those are all of the easily treatable and life threatening conditions we should not miss. Your next options for investigation would be a 24 hour pH study with consideration for fundoplication. This is a major surgery with risks and complications that are believed to be worse than PPI therapy. Patients who fail PPI, are unable to be weaned, or have contraindications are the ideal candidates for such an invasive procedure. You don’t want to send every heartburn patient to fundoplication, we used to do that and made a lot of people worse.

DantesKite 4y ago

> If your wife had hemoglobin that low, then she was correctly diagnosed with anemia. That seems like a somewhat myopic perspective. Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness. A more accurate and helpful diagnosis would probably be something like "Babesiosis"——anemia caused by ticks infected with a microbe that destroys red blood cells especially considering the multiple cofactors at play. Or whatever it was that specifically caused the anemia; the parent comment didn't say.

danachow 4y ago
Dude, I'm just addressing this: "So things that can look like anemia can be other things! Case in point, my wife was misdiagnosed for months with Anemia." Which is a bit of a confused statement. > Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness. No, that's a pretty shit analogy and completely wrong. First, because chemotherapy doesn't cause "male pattern baldness" - the mechanisms aren't the same. So that's just wrong - while someone with a hemoglobin of 4 has anemia, whatever the underlying cause may be - it isn't a look alike - it is. Second, diagnosing Alopecia (secondary to chemotherapy) is a perfectly reasonable diagnosis. Because it is something that doctors do manage with specific things separately from the chemotherapy and other cancer treatment, eg wigs, scalp cooling. People can have more than one relevant diagnosis that they are treated for and are interrelated. For instance, if someone has anemia that is due to something like a GI bleed, they have both a GI bleed and anemia. If their hemoglobin is less than 7 you will likely treat that anemia with a blood transfusion independent of what you're doing to manage the GI bleed. GI bleed, iron deficiency, malabsorption, microcytic anemia are all diagnoses - they may be all interrelated. > A more accurate and helpful diagnosis would probably be something like "Babesiosis"--anemia caused by ticks But babesiosis is not anemia. It often occurs with it, but the diagnostic criteria for babesiosis is blood smear or PCR. If someone has a smear positive for babesia then they have babesiosis regardless of their Hgb/Hct. And notably they listed a bunch of tick borne illnesses listed, babesiosis was not among them.
- Pigalowda 4y ago
  - danachow 4y ago
    > I’m sure you’re here to rub your reflex hammer in our ignorant little pig faces. I do realize there are a lot of crappy doctors out there, but about the person putting a reflex hammer in your face -- are you sure that was an actual doctor? To your other point, while I often realize the futility of responding to the direct commenter, this is a public forum so maybe others can get some information or entertainment, whatever might be.
    - Pigalowda 4y ago
    - haldujai 4y ago
      As a physician I am in complete agreement with danachow’s statements. A hemoglobin of 4 must be corrected irrespective of the underlying etiology. Furthermore, I am also in complete agreement that such a patient without obvious source for anemia requires a hematology consultation. That may be the only error that happened here. I would greatly welcome your rationale as to how we can safely discharge a symptomatic patient with a Hgb of 4 as this directly contradicts all of my medical training. In fact, I would lose my license if I ever did that. If you happen to know information about anemia I do not, please provide your rationale.
      - com2kid 4y ago
        I've gone into the doctor with a BP of 160/90 and a headache that had been with me for 3 days. After asking some scary questions and ruling out that I wasn't going to die then and there, I was sent on my way and told good luck. I figured out myself that the problem was a potassium deficiency. I hadn't eaten any leafy greens in a week or two (lots of veggies, just none that had significant levels of potassium) and I don't normally eat any processed food. A couple handfuls of baby spinach later and my headache was gone. A lack of effort in diagnosis is the norm, not the exception. I have plenty of other stories! As does damn nearly every one else. Computer techs don't bother diagnosing PC problems and just prescribe a reboot. Many Doctors seem to have the same attitude, but for the patient things are a bit more personal.
medymed 4y ago
Right idea generally but in that scenario it would be like making a diagnosis of alopecia which just means hair loss. In any case some diagnoses don’t have clear explanations or subdivisions for decades or centuries until explanatory medical science catches up with the descriptive diagnoses like anemia or alopecia.
- deleted 4y ago
  [deleted]

code_duck 4y ago

The difference is actually finding the root cause or just diagnosing what’s essentially a symptom as if it’s unexplained or isolated (idiopathic, I think is the term?). My mother was diagnosed with anemia, and received many recommendations ranging from not drinking tea to getting a hysterectomy (which was done, in her mid 40s). It turned out she wasn’t absorbing iron due to Celiac disease. Treating the anemia as if it was an isolated condition wasn’t helpful at all since she needed to address the root cause, Celiac.

haldujai 4y ago
“Anemia” isn’t really a diagnosis. Your mother had a microcytic anemia (a broad class based on lab results), of which there are several types including iron deficiency anemia. Next, there are multiple causes of iron deficiency anemia of which celiac disease is one of them. You would never diagnose a patient with “anemia” and stop there. Further work up for the etiology is mandatory and endoscopy is commonly performed. There is no such thing in modern medicine as “just treating anemia” unless you know the cause and the only treatment is transfusions.
- DangitBobby 4y ago
  > You would never diagnose a patient with “anemia” and stop there. I kind of doubt that. In my experience, the treatment for chronic heartburn is to throw meds at it to stop the symptoms. After an upper endoscopy, no attempt at root cause was ever made.
  - haldujai 4y ago
    As much as you doubt that based on your anecdotal experience (addressed below), I’ve respectfully spent the past 9 years practicing medicine in 16 different hospitals across three countries and feel I am in a more appropriate position to comment on the medical standard of care. I can say with absolute confidence at none of the places I’ve worked at would a doctor leave a patient with a diagnosis of anemia as this is malpractice. Are there physicians in some hospitals who practice negligently? Sure, but there are also pilots who show up drunk to work and engineers who are negligent. That doesn’t mean the entire profession has a “problem”. Anemia is not heartburn. Anemia can be life threatening. As an analogy for the tech world. Anemia is a server crash. Heartburn is a warning in the server logs. You may decide the warning is not worth fixing / may result in new bugs (aka complication). When a server crashes step 1 is to get it back online (transfuse to a safe hemoglobin target). Step 2 is find out why the server crashed (why is this patient anemic, which is a sign/symptom and not a diagnosis). Just as a computer engineer would never say “I’m not sure why but let’s just keep restarting every time it crashes”, a doctor would not say “I’m not sure why you’re anemic” unless there was an extensive negative workup and the patient normalized therefore no longer requiring treatment. There is no situation where a physician just keeps transfusing an anemic patient without figuring out why. This is not only expensive, but transfusions carry risks and with repeated transfusions some risks increase. This is not a medically accepted management plan anywhere and the hospital / blood bank would quickly intervene if a non-hematologist was serially transfusing a patient as this is outside their scope. In your example: Your negative endoscopy excluded H. pylori, gastric malignancy, peptic ulcer disease, and a hiatal hernia. Those are all of the easily treatable and life threatening conditions we should not miss. Your next options for investigation would be a 24 hour pH study with consideration for fundoplication. This is a major surgery with risks and complications that are believed to be worse than PPI therapy. Patients who fail PPI, are unable to be weaned, or have contraindications are the ideal candidates for such an invasive procedure. You don’t want to send every heartburn patient to fundoplication, we used to do that and made a lot of people worse.