<s>[INST] hi doctor, my aunt is a 55 year old lady who is suffering with abnormally low haemoglobin count (2.7%). She is also suffering with some digestion issues also like acidity since last many years. Her medication is also going on since many years but none of the medicine has yet resolved the issue of low hemoglobon count completely. This is a recurring issue & comes after every few months. She has a habit of chewing Pan Masala. Is this leading to all the health problems. [/INST] Hello Thanks for the query. Your aunt is suffering from severe anaemia.(2.7) is a very severe anaemia and will take a very long time for correction with medication . Moreover taking medications for aneamia for a long time leads to gastritis and increased acidity. She needs to be evaluated for such low haemoglobin levels and the cause of her anemia should be treated.That could be due to increased blood loss during mensturation or bleeding haemorrhoids(Piles) Please get your Aunt to a good physician and get her examination and routine blood invetigations done. she may also need blood transfusion or Haematinic Injections to increase her haemoglobin levels. Pan Masala cause Gastritis and may cause peptic ulcer and  upper G.I. Bleeding for which an endoscopy is needed. Ask your aunt to stop eating Pan Masala. Wish your Aunt good health. </s>