<s>[INST] hi Making this query for my father, who is 58 yrs his HB count shows 19. He is facing some problems like redness(mixed with purple) on the finger tips and pain, fatigue, low back pain etc. Would like to know what will be the reason and treatment. [/INST] Here as per your explanation, having HE 19 is something perfect. But I need to know what about other parameters like is he having sugar (diabetes)? Well if he is not diabetic then next is what about hypertension, cholesterol or any other medical history.? If he is healthy and this is first time something happening different from I suggest to check on his back pain. Is it coming from back to leg along with numbness and tingling sensation. If yes then his problem is at spinal level which is affecting the nerve coming from that particular level and so that he has pain and sensory changes at lower end of the leg where ever the nerve supplies. But if there are no symptoms of radiating pain then it could be something related to vascularity where his lower limb circulation might be affected. Now to have conformation on this there is physical test that is hold and squeeze his calf muscle and check about pain if he complains of pain then the test is positive showing abnormality in circulation for lower limb. However the conformation can be done only after Doppler test for lower limb. Here just with symptoms of redness in fingertip, fatigue, pain is not enough for any diagnosis it can also be related to simple fever where you will have similar symptoms. Soni suggest taking him to doctor in case the symptoms are not going on its own and get him examine properly and do needful. Take care. </s>