Hemoglobin mild anemia

WHO's severity bands come from a 1989 rule applied to the 2024 cutoffs: mild is above 80 percent of the cutoff, moderate 60 to 80 percent, severe below 60. For men that is 110 to 129 g/L (11.0 to 12.9 g/dL); for non-pregnant women 110 to 119 (11.0 to 11.9). WHO attaches one remark to the whole table: "The management for individuals with mild, moderate, or severe anaemia could vary depending on the clinical scenario and the underlying cause(s) of the anaemia." The band names a degree, not a diagnosis.

What mild usually feels like. The NHLBI: "If you have mild anemia, you may not have any symptoms," and "People who have mild anemia may not need treatment." It also says mild anemia "is a common and treatable condition that can develop in anyone" and that the most common type is iron deficiency. That is the reassurance. The caution comes from the gastroenterologists: the BSG advises that "investigation should be considered at any level of anaemia in the presence of iron deficiency," because the fast-track referral thresholds "will however miss some cases of colorectal cancer, especially in men."

The first tests. The AGA's 2020 guideline: "In patients with anemia, AGA recommends using a cutoff of 45 ng/mL over 15 ng/mL when using ferritin to diagnose iron deficiency." The BSG explains the numbers: ferritin under 15 µg/L is highly specific for iron deficiency (0.99), 45 gives a specificity of 0.92, and above 150 absolute iron deficiency "is unlikely to occur ... even in the presence of inflammation." Alongside ferritin the BSG reads the red cell indices (MCH and MCV), transferrin saturation, C-reactive protein, and reticulocyte hemoglobin, and it flags thalassemia carriage as a reason for microcytosis with normal iron studies. Failure to respond to iron has its own list, which includes "concurrent deficiency of vitamin B12 or folic acid."

Who gets scoped. AGA: "In asymptomatic postmenopausal women and men with iron deficiency anemia, AGA recommends bidirectional endoscopy over no endoscopy," and it suggests the same for asymptomatic premenopausal women over iron alone. The BSG lands differently for young women: after screening for celiac disease, which it finds in up to 4 percent of cases, "further investigation is warranted only if there are additional clinical features of concern," such as age over 50, no periods, red-flag symptoms, a strong family history, or anemia disproportionate to menstrual loss. Both bodies screen for celiac disease serologically.

Treatment and the retest. BSG: one tablet a day of ferrous sulfate, fumarate or gluconate, or every other day if not tolerated; a rise of 10 g/L within 2 weeks "is highly suggestive of absolute iron deficiency"; monitor in the first 4 weeks; continue about 3 months after hemoglobin normalizes; then check the count every 3 months for a year and every 6 months for 2 to 3 years, because anemia "recurs in a minority."