Four-year-old Sienna Dunion had initially flu-like symptoms, however her condition rapidly worsened, leading to a coma. What seemed like a simple flu was actually Acute Necrotising Encephalitis (ANE), a rare and severe brain disorder. After undergoing multiple surgeries and having removed 60% of her intestines, she is now struggling to walk and talk like from before.

How Did It Begin?

The first indication, which was very easy to miss was when she asked to return home five minutes after heading out to play with her scooter, reports The Independent. She had always been happy and exciting, so for her to return home so soon was not normal. She had also complained about feeling "cold and chilly" to her older sister, however, all of such symptoms were just seen as a common cold or flu signs.

As a result, her parents, Gary and Angelina Dunion, decided to keep her off school on Monday 17 November. Her temperature raised, no one was really concerned. All of these were cold and flu symptoms. She was still playing with her Barbies.

But it was on a Wednesday morning when she became unresponsive and had to make an emergency trip to A&E in Kettering. This is when she was induced into coma and diagnosed with the rare brain disease ANE.

Three weeks later, her family is facing the challenges to cope with the new changes which may take away how her daughter was before. Now, she requires years of intense rehabilitation to learn how to walk and talk again.

What is Acute Necrotising Encephalitis (ANE)?

Acute necrotizing encephalopathy (ANE) is a rare and serious brain condition that can cause sudden and rapid neurological decline after a viral infection, most often the flu or COVID-19. Because only a small number of cases have been reported worldwide, there is no standard treatment, making diagnosis and management especially difficult.

Sienna's father told The Independent, "For us, it’s really important that people can understand this has happened to a really healthy four-year-old girl who had no underlying issues. It has completely changed our lives overnight. What started as a flu has turned into a complicated brain disease and the last three weeks have just been horrendous.”

A Rare Diagnosis, But Urgent Care

Sienna had been feeling unwell on Monday and Tuesday, but it was on November 19 that her condition suddenly worsened. Her mother, Mrs Dunion, became alarmed when she tried to wake her and realised Sienna was unresponsive.

At A&E, doctors initially believed she was dehydrated after she tested positive for influenza. However, a CT scan showed unusual findings, including white lesions, while other test results remained unclear.

By 11 pm, doctors decided Sienna needed to be moved to the intensive care unit at Nottingham’s Queen’s Medical Centre. An MRI scan later confirmed a diagnosis of acute necrotising encephalopathy (ANE), a rare condition linked to viral infections.

Because of how uncommon the disease is, doctors designed a personalised treatment plan for her. This included plasma exchange, a procedure her family described as effectively washing her brain.

On Saturday, November 22, an ultrasound revealed a large build-up of fluid in her stomach. Sienna had to undergo emergency surgery, during which 60 per cent of her intestines were removed. Her father called it the hardest night of his life.

She later needed two more surgeries after air was found in her abdomen. Sienna now has a stoma bag and will live with short bowel syndrome for the rest of her life.

“The one thing doctors have been clear about is that she will not be the same when she fully wakes up,” Mr Dunion said. “She will need extensive rehabilitation.”

Although Sienna is awake, her father explained that she does not understand what is happening around her. She is weak, struggles to track with her eyes, and cannot eat on her own. The family is now fundraising to support her rehabilitation, including physiotherapy, speech and language therapy, feeding support, and changes needed at home.

A family struggling to cope

The couple also have a seven-year-old daughter, who is very close to Sienna. “They are best friends,” Mr Dunion said. “She keeps asking, ‘Where is Sienna? When can we be a family again?’”

He added that it is impossible to explain the seriousness of the situation to her. “I can’t tell her that she won’t be able to talk to her sister for a long time.”

“She was the most caring, easygoing four-year-old I’ve ever known,” her father said. “Even when she had a fever, she would check our temperature to make sure we were okay.”

He described her as a social child who loved being around other kids and had an infectious belly laugh. “We just don’t know if we’ll hear that laugh again,” he said.

Hemoglobin is a key protein found in red blood cells. Its main job is to carry oxygen from your lungs to the rest of your body. When hemoglobin levels drop, the body may not receive enough oxygen to function well. Low hemoglobin can happen for several reasons, including health conditions, blood loss, or gaps in nutrition.

What Is Low Hemoglobin?

Hemoglobin is the oxygen-carrying protein in red blood cells. Adequate hemoglobin levels are essential for keeping organs and tissues properly supplied with oxygen. Without enough of it, the body begins to struggle to meet its basic energy needs.

Low hemoglobin is usually identified through a blood test. It is most often measured as part of a complete blood count (CBC), which checks different components of the blood, including red and white blood cells and platelets, as per Healthline.

While exact reference ranges can vary slightly between laboratories, healthy adult hemoglobin levels usually fall within the ranges listed below. These values are different for babies, children, and teenagers.

Normal Hemoglobin Count in Grams per Deciliter (g/dL) | Normal Hemoglobin Count in Grams per Liter (g/L)

Adult Males: 13.8–17.2 | 138–172

Adult Females: 12.1–15.1 | 121–151

Any reading below these ranges in adults is considered low hemoglobin and suggests that oxygen delivery in the body may be reduced, as per Mayo Clinic.

Is Low Hemoglobin Ever Dangerous?

Low hemoglobin is not always an emergency. In many cases, it develops gradually and can be managed with treatment. That said, very low levels can be dangerous. A hemoglobin level below 5.0 g/dL has been linked to serious complications, including heart failure and even death. Levels under 6.5 g/dL may be considered life-threatening and require urgent medical care.

What Causes Low Hemoglobin?

One of the most common reasons for low hemoglobin is anemia. Anemia occurs when the body does not have enough healthy red blood cells. The most frequent type is iron-deficiency anemia, which develops when the body lacks enough iron to produce hemoglobin.⁵

Other forms of anemia include pernicious anemia, which occurs when the body cannot properly absorb vitamin B12, and hemolytic anemia, where red blood cells are destroyed faster than they are produced.¹

Low hemoglobin can also be caused by:

• Blood loss or internal bleeding
• Certain cancers, including leukemia, lymphoma, multiple myeloma, and cancers that spread to the bone marrow
• Chronic kidney disease
• Deficiencies of folate or vitamin B12
• Hypothyroidism
• Liver disease
• Poor nutrition or malnutrition
• Myelodysplastic syndrome (MDS)
• Sarcoidosis
• Sickle cell disease and other inherited blood disorders
• Systemic lupus erythematosus
• Thalassemia, a genetic condition that reduces hemoglobin production
• Excess fluid in the body
• Cancer treatments such as chemotherapy and radiation can also lower hemoglobin levels, particularly in adults over the age of 65.

What Does Having Low Hemoglobin Feel Like?

Some people with mildly low hemoglobin may not notice any symptoms at first. Others may begin to feel unwell as levels drop further or remain low over time.

Common signs and symptoms include:

• Feeling dizzy or lightheaded, sometimes fainting
• Muscle weakness
• Ongoing fatigue or low energy
• Pale or washed-out skin
• Frequent headaches

How Is Low Hemoglobin Treated?

Treatment depends entirely on what is causing the low hemoglobin. A healthcare provider will first identify the underlying reason before recommending treatment.

Possible treatment options include:

Blood transfusion: If hemoglobin is low due to heavy blood loss, a transfusion may be needed to restore levels quickly.

Vitamin supplements: When nutritional deficiencies are the cause, iron, folate, or vitamin B12 supplements are often prescribed. Hemoglobin levels usually begin to improve within six to eight weeks.

Intravenous (IV) therapy: In cases where iron or B12 levels need to be raised rapidly, IV infusions may be recommended.

Bone marrow transplant: This may be required when low hemoglobin is linked to certain cancers or bone marrow disorders.

If a long-term illness is responsible, managing that condition becomes the key part of treatment, alongside monitoring hemoglobin levels regularly.

One particularly vulnerable group across the UK is being strongly advised to receive up to three vaccines this season. This winter has seen a sharp rise in seasonal viruses, with the NHS warning that hospitals and ambulance services are under significant pressure due to higher demand.

This surge is largely driven by the H3N2 flu strain, known as subclade K, which is currently circulating at ‘medium’ levels but with increased activity. The UK Health Security Agency reports that flu-related hospital admissions have climbed to 7.79% per 100,000, up from 4.78% per 100,000 the previous week.

While common winter viruses such as flu, RSV, and whooping cough can cause uncomfortable symptoms for most people, certain groups face a higher risk of serious complications. These include children, older adults, people with weakened immune systems, and pregnant women.

Why You Should Get Vaccinated While Pregnant

Flu shots are highly effective at protecting both mothers and their babies, as the body responds differently to infections during pregnancy. NHS guidance notes that pregnant women are more susceptible to complications from viral infections, particularly in the later stages of pregnancy.

Infants are also at a higher risk of severe illness if exposed to viruses, which can sometimes result in mothers and babies requiring intensive care. Additionally, infections like flu can increase the risk of premature birth or low birth weight, which may raise the chance of stillbirth or neonatal death.

Posting on X, the UK Health Security Agency said that pregnant women are entitled to vaccinations against flu, RSV, and whooping cough, and advised them to consult their midwife, GP, or local pharmacist for guidance on getting vaccinated.

How Vaccines Protect Pregnant Mothers And Their Babies

Vaccination during pregnancy passes protective antibodies to the baby, giving them similar levels of defence against serious illness in the first weeks of life. This applies to vaccines for flu, whooping cough, and RSV, helping shield both mother and newborn.

Vaccines Pregnant Women Aren't Advised To Get

Pregnant women are generally advised to avoid vaccines that contain a live version of a virus, as these could theoretically infect the unborn child. However, evidence shows live vaccines do not typically cause birth defects.

The main exception is when the risk of infection is higher than the potential risk from the vaccine itself. Examples of live vaccines include:

• Yellow fever
• Measles, mumps, and rubella (MMR)
• Tuberculosis (BCG vaccine)

Is It Safe To Get A Flu Shot During Pregnancy?

The American College of Obstetricians and Gynecologists advises that anyone who is pregnant during flu season should receive the flu shot, regardless of which trimester they are in.

A flu vaccine during pregnancy can help in several ways:

Lower the risk of flu-related illness during pregnancy

Pregnancy changes how the immune system, heart, and lungs function, which can make flu infections more severe. A flu shot reduces the chance of catching the flu and lowers the risk of needing hospital care if you do get sick.

Reduce risks to the developing baby

Getting the flu, especially early in pregnancy, may increase the risk of certain health problems in the unborn baby. Flu infection has also been linked to a higher chance of birth-related complications.

Protect the baby after delivery

Newborns are more likely to become seriously ill from the flu, but they cannot be vaccinated until they are six months old. Antibodies produced after a flu shot during pregnancy cross the placenta and are also found in breast milk, helping protect the baby in the first months of life.

When getting vaccinated, pregnant women should choose the flu shot, not the nasal spray. The injection uses an inactive virus and is safe at any stage of pregnancy. The nasal spray contains a live virus and is not recommended for pregnant women.

The NHS has released an alert for people taking a widely prescribed medication used by millions across the UK. Diabetes rates are at an all-time high, with the latest data showing more than 5.8 million people currently living with the condition.

Diabetes UK estimates that around 4.6 million people have already been diagnosed. At the same time, close to 1.3 million people are believed to have Type 2 diabetes without knowing it. The number of cases continues to climb, with figures from 2023–24 showing an increase of 185,034 compared to the previous year.

What Is Metformin Used For?

Metformin is most commonly prescribed for people with Type 2 diabetes. It helps lower and stabilise blood sugar levels and is often the first medicine recommended, alongside changes to diet and physical activity. According to Healthline, it is not used to treat Type 1 diabetes.

What Is Diabetes?

Diabetes is a condition where blood sugar levels become too high. There are three main types. Type 1 diabetes cannot be prevented and is usually diagnosed in childhood. Type 2 diabetes can sometimes be prevented or managed through lifestyle changes such as healthier eating, regular exercise, and weight loss. Gestational diabetes develops during pregnancy. People with Type 1 diabetes need insulin for life, while many with Type 2 or gestational diabetes may manage their condition through lifestyle changes and, in some cases, medication.

Metformin Warning: NHS Issues Alert

The NHS says that people taking metformin should be aware of certain symptoms. Information published on the NHS website lists six common side effects of the medicine. These include:

• feeling sick
• being sick
• diarrhoea
• stomach pain
• loss of appetite
• a metallic taste in the mouth

The NHS also notes that metformin can increase the risk of vitamin B12 deficiency. Some people may experience low blood sugar, but this usually happens only when metformin is taken alongside other diabetes medicines such as insulin or gliclazide.

However, the NHS warns that there are other, more serious side effects. In two situations, patients are advised to contact their GP “straight away,” while one requires calling 999 “now.”

Metformin Serious Side Effects

According to the NHS, serious side effects are uncommon and affect fewer than 1 in 10,000 people. However, medical help should be sought immediately by calling a doctor or dialling 111 if:

you feel generally unwell with extreme tiredness, fast or shallow breathing, feeling cold, and a slow heartbeat

the whites of your eyes turn yellow, or your skin becomes yellow, which may be harder to notice on brown or black skin, as this can indicate liver problems

Metformin Serious Allergic Reaction

In rare cases, metformin can cause a severe allergic reaction known as anaphylaxis. The NHS advises calling 999 immediately if:

• your lips, mouth, throat, or tongue suddenly swell
• you are breathing very quickly or struggling to breathe, including wheezing or feeling as though you are choking
• your throat feels tight or you have difficulty swallowing
• your skin, tongue, or lips turn blue, grey, or pale, which may be easier to spot on the palms or soles in people with darker skin
• you suddenly feel confused, very drowsy, or dizzy
• someone collapses and cannot be woken
• a child becomes limp, floppy, or unusually unresponsive, with difficulty holding up their head or focusing

The NHS adds that you or the affected person may also develop a rash that is swollen, raised, itchy, blistered, or peeling. These signs point to a serious allergic reaction and may require urgent hospital treatment.