Maintaining a healthy hemoglobin (Hb) level is essential for carrying oxygen throughout the body. However, many people continue to struggle with low hemoglobin even after taking iron supplements.

This condition is known as refractory anemia—and it requires a systematic evaluation.

This article explains why hemoglobin may not increase, and the important laboratory tests needed to identify the root cause.

🌟 What Is Hemoglobin & Why Is It Important?

Hemoglobin is a protein found in red blood cells (RBCs) that transports oxygen from the lungs to all parts of the body.
Low hemoglobin results in anemia, causing fatigue, weakness, and reduced immunity.

When hemoglobin does not rise with treatment, deeper causes need to be investigated.

✔️ Why Hemoglobin Does Not Increase: Common Causes

Low hemoglobin may persist due to:

Iron deficiency
Poor iron absorption
Vitamin B12 or folate deficiency
Chronic diseases (kidney or liver disease)
Hypothyroidism
Blood loss (internal or external)
Parasite infection
Genetic blood disorders (Thalassemia trait)
Bone marrow suppression

Identifying the exact cause is only possible through the right tests.

🔍 Important Tests When Hemoglobin Does Not Increase

Below are the essential investigations recommended by doctors:

1️⃣ Complete Blood Count (CBC)

This is the first and most important test. It evaluates:

Hemoglobin
RBC count
Hematocrit
MCV, MCH, MCHC
RDW
Platelet count

It helps classify anemia into microcytic, macrocytic, or normocytic types.

2️⃣ Iron Studies

To confirm true iron deficiency:

Serum Ferritin
Serum Iron
TIBC (Total Iron Binding Capacity)
Transferrin Saturation
UIBC

Low ferritin = iron deficiency anemia (most common)

3️⃣ Vitamin Levels

Deficiencies of these vitamins stop RBC formation:

Vitamin B12
Folate (Vitamin B9)

Both must be checked if MCV is high.

4️⃣ Thyroid Profile

Hypothyroidism slows RBC production:

TSH
FT3 & FT4 (if needed)

5️⃣ Kidney Function Tests

Kidneys produce erythropoietin, which stimulates RBC production.

Tests:

Serum Creatinine
BUN
eGFR

Low eGFR → chronic kidney disease → anemia.

6️⃣ Liver Function Tests (LFT)

Liver disorders affect hemoglobin and blood clotting:

AST, ALT
ALP, GGT
Bilirubin
Albumin

7️⃣ Blood Sugar Tests

Long-standing diabetes affects kidney and blood production:

Fasting Blood Sugar
HbA1c

8️⃣ Stool Examination

To detect blood loss, worms, or malabsorption:

Stool for Occult Blood
Stool Ova & Parasite

Hookworm is a common cause of persistent anemia.

9️⃣ Urine Routine Test

To check for:

Blood
Protein
Kidney issues

🔟 Infection & Inflammation Tests

Chronic infection suppresses blood production:

ESR
CRP

🩺 Treatment Depends on Test Results

After identifying the cause, doctors may recommend:

Iron supplements or injections
Vitamin B12/Folate therapy
Deworming medicine
Thyroid correction
Kidney disease management
Treating gastritis or malabsorption
Blood transfusion (if very low Hb)
Managing chronic infections
Genetic counseling (if thalassemia)

🌿 How to Naturally Improve Hemoglobin

Along with treatment:

Eat iron-rich foods: spinach, jaggery, beetroot, dates, liver, eggs
Include vitamin C foods to increase absorption
Avoid tea/coffee immediately after meals
Stay hydrated
Treat gastritis or acidity
Regular deworming (every 6 months)

⭐ Conclusion

Persistent low hemoglobin is not a simple problem—it often indicates an underlying condition.
A proper combination of blood, urine, stool, vitamin, thyroid, and iron studies helps identify the exact cause and guide correct treatment.

If hemoglobin does not rise, always consult a physician or hematologist for a full evaluation.

.....................................................End.................................................................