What are the causes of elevated hemoglobin levels. How is a high hemoglobin count diagnosed and treated. Why is understanding hemoglobin important for overall health.

Understanding Hemoglobin: The Oxygen-Carrying Protein

Hemoglobin is a crucial protein found in red blood cells, responsible for transporting oxygen throughout the body. Its importance extends beyond mere oxygen delivery, as it also gives blood its characteristic red color due to the iron content. Maintaining proper hemoglobin levels is essential for overall health and well-being.

Normal hemoglobin ranges vary between genders:

• Men: 14 to 17 gm/dL (grams per deciliter)
• Women: 12 to 15 gm/dL

These ranges can be influenced by various factors, including age, race, and general health status. Healthcare providers often measure hemoglobin as part of a complete blood count (CBC), which provides valuable insights into a person’s health condition.

The Role of Hemoglobin in Health Assessment

Hemoglobin levels serve as an indirect indicator of red blood cell count in the body. When these levels exceed the normal range, it may signal underlying health issues that require attention. Understanding the significance of hemoglobin can help individuals take proactive steps in managing their health.

Causes of Elevated Hemoglobin Levels

High hemoglobin counts can stem from various sources, ranging from lifestyle factors to medical conditions. Identifying the root cause is crucial for appropriate management and treatment.

Medical Conditions Associated with High Hemoglobin

Several health conditions can lead to elevated hemoglobin levels:

1. Polycythemia vera: A bone marrow disorder resulting in excessive red blood cell production
2. Lung diseases: Chronic obstructive pulmonary disease (COPD), emphysema, and pulmonary fibrosis
3. Heart conditions: Particularly congenital heart diseases present from birth
4. Kidney tumors: Can stimulate increased red blood cell production
5. Dehydration: Often due to diarrhea or insufficient fluid intake
6. Hypoxia: Low blood oxygen levels
7. Carbon monoxide exposure: Commonly associated with smoking

Lifestyle Factors Influencing Hemoglobin Levels

Certain lifestyle choices and environmental factors can also contribute to high hemoglobin counts:

• Smoking cigarettes
• Living at high altitudes
• Use of performance-enhancing drugs (e.g., anabolic steroids, erythropoietin)

Diagnosing High Hemoglobin Counts

Elevated hemoglobin levels are typically discovered during routine blood tests or when investigating other health concerns. Upon finding a high hemoglobin count, healthcare providers may initiate further testing to determine the underlying cause.

Additional Diagnostic Procedures

To pinpoint the reason for elevated hemoglobin, doctors may order:

• Comprehensive metabolic panel
• Arterial blood gas analysis
• Bone marrow biopsy
• Genetic testing for hereditary conditions

These tests aim to identify conditions that may be causing the body to overproduce red blood cells or restrict oxygen supply, leading to compensatory increases in hemoglobin production.

Treatment Options for High Hemoglobin

The approach to treating high hemoglobin counts depends on the underlying cause. In some cases, addressing the root condition can help normalize hemoglobin levels.

Phlebotomy: A Common Treatment Procedure

One of the primary treatments for high hemoglobin is phlebotomy, a procedure where blood is drawn to reduce the overall red blood cell count. This process involves:

1. Inserting a needle into a vein
2. Draining blood into a sterile bag or container
3. Repeating the procedure as necessary until hemoglobin levels normalize

Phlebotomy can be an effective way to manage conditions like polycythemia vera, where the body produces too many red blood cells.

Lifestyle Modifications to Manage Hemoglobin Levels

In addition to medical treatments, certain lifestyle changes can help manage high hemoglobin counts:

• Quitting smoking
• Staying properly hydrated
• Avoiding performance-enhancing drugs
• Managing underlying health conditions effectively

These modifications can contribute to overall health improvement and help maintain appropriate hemoglobin levels.

The Impact of High Hemoglobin on Overall Health

Elevated hemoglobin levels can have various effects on the body, potentially leading to complications if left unaddressed. Understanding these impacts is crucial for proper management and prevention of related health issues.

Potential Complications of High Hemoglobin

Persistently high hemoglobin counts may result in:

• Increased blood viscosity
• Higher risk of blood clots
• Impaired blood flow to vital organs
• Cardiovascular complications

Recognizing these potential risks emphasizes the importance of monitoring and managing hemoglobin levels effectively.

Preventive Measures and Regular Monitoring

Maintaining healthy hemoglobin levels involves a combination of preventive strategies and regular health check-ups. Individuals can take proactive steps to ensure their hemoglobin counts remain within normal ranges.

Importance of Regular Blood Tests

Routine blood tests, including complete blood counts, play a vital role in:

• Early detection of abnormal hemoglobin levels
• Monitoring the effectiveness of treatments
• Identifying potential underlying health conditions

Regular health screenings allow for timely interventions and adjustments to treatment plans when necessary.

Hemoglobin and Athletic Performance

The relationship between hemoglobin levels and athletic performance has garnered significant attention in the sports world. While optimal hemoglobin levels can enhance oxygen delivery to muscles, artificially elevating these levels through doping practices is both dangerous and unethical.

The Controversy of Blood Doping

Blood doping, particularly through the use of erythropoietin (EPO), has been a contentious issue in competitive sports. This practice involves:

• Artificially increasing red blood cell production
• Enhancing oxygen-carrying capacity
• Potentially improving endurance and performance

However, the health risks associated with blood doping, including increased risk of heart attacks and strokes, far outweigh any potential performance benefits. Sports organizations worldwide have implemented stringent testing protocols to detect and prevent such practices.

Understanding the natural fluctuations in hemoglobin levels and their impact on athletic performance can help athletes and coaches develop safe and effective training strategies. Focusing on proper nutrition, hydration, and altitude training can naturally optimize hemoglobin levels within healthy ranges.

Altitude Training and Hemoglobin Adaptation

Living or training at high altitudes can naturally increase hemoglobin levels as the body adapts to lower oxygen availability. This adaptation process involves:

1. Increased production of erythropoietin by the kidneys
2. Stimulation of red blood cell production in the bone marrow
3. Gradual increase in hemoglobin concentration

Athletes often utilize altitude training to enhance their oxygen-carrying capacity naturally, providing a legal and safe alternative to artificial blood doping methods.

Hemoglobin Disorders and Genetic Factors

While this article primarily focuses on high hemoglobin counts, it’s important to recognize that various genetic factors can influence hemoglobin production and function. Understanding these genetic components can provide valuable insights into hemoglobin-related disorders.

Common Hemoglobin Disorders

Several genetic conditions affect hemoglobin structure or production:

• Sickle cell disease: Causes abnormal hemoglobin structure
• Thalassemia: Results in decreased hemoglobin production
• Hemoglobinopathies: Various disorders affecting hemoglobin function

These conditions highlight the complexity of hemoglobin genetics and the importance of comprehensive genetic testing when diagnosing hemoglobin-related disorders.

Genetic Testing and Counseling

For individuals with a family history of hemoglobin disorders or those planning to have children, genetic testing and counseling can provide valuable information. This process may involve:

1. Analyzing family medical history
2. Conducting specific genetic tests
3. Providing counseling on potential risks and management strategies
4. Discussing reproductive options for carriers of hemoglobin disorders

Understanding the genetic factors influencing hemoglobin can empower individuals to make informed decisions about their health and family planning.

Hemoglobin and Cardiovascular Health

The relationship between hemoglobin levels and cardiovascular health is complex and multifaceted. While adequate hemoglobin is crucial for oxygen delivery to tissues, excessively high levels can pose risks to heart health.

Impact of High Hemoglobin on the Cardiovascular System

Elevated hemoglobin levels can affect the cardiovascular system in several ways:

• Increased blood viscosity, making it harder for the heart to pump blood
• Higher risk of blood clot formation
• Potential strain on blood vessels and heart muscles
• Increased risk of hypertension and related complications

Understanding these impacts underscores the importance of maintaining hemoglobin levels within healthy ranges for optimal cardiovascular function.

Monitoring Cardiovascular Health in High-Risk Individuals

For individuals with persistently high hemoglobin levels, regular cardiovascular monitoring may be recommended. This can include:

1. Regular blood pressure checks
2. Echocardiograms to assess heart function
3. Stress tests to evaluate cardiovascular fitness
4. Monitoring of other cardiovascular risk factors

By closely monitoring cardiovascular health, healthcare providers can intervene early to prevent potential complications associated with high hemoglobin levels.

Nutrition and Hemoglobin Management

While diet alone may not significantly lower hemoglobin levels in cases of overproduction, maintaining a balanced diet is crucial for overall health and can support the body’s natural hemoglobin regulation processes.

Dietary Considerations for Hemoglobin Management

Certain dietary approaches may be beneficial for individuals managing high hemoglobin levels:

• Adequate hydration to maintain proper blood volume
• Balanced iron intake to avoid excessive supplementation
• Consumption of foods rich in antioxidants to support overall blood health
• Limiting alcohol intake, which can affect red blood cell production

Consulting with a registered dietitian can provide personalized nutritional guidance for individuals with hemoglobin concerns.

The Role of Supplements in Hemoglobin Regulation

While supplements can play a role in managing hemoglobin levels, their use should be carefully monitored:

1. Iron supplements should only be taken under medical supervision
2. Vitamin B12 and folate may be recommended in cases of deficiency
3. Herbal supplements claiming to affect hemoglobin should be approached with caution
4. Any supplementation should be discussed with a healthcare provider

Understanding the appropriate use of supplements can help individuals avoid unintended consequences and support healthy hemoglobin levels.

Future Directions in Hemoglobin Research and Treatment

As our understanding of hemoglobin and its role in health continues to evolve, new avenues for research and treatment are emerging. These developments hold promise for improved management of hemoglobin-related disorders and conditions.

Emerging Therapies and Technologies

Several innovative approaches are being explored in the field of hemoglobin research:

• Gene therapy for hemoglobin disorders
• Development of artificial hemoglobin substitutes
• Advanced monitoring technologies for real-time hemoglobin measurement
• Personalized medicine approaches based on genetic profiles

These advancements may lead to more targeted and effective treatments for individuals with hemoglobin abnormalities.

The Role of Artificial Intelligence in Hemoglobin Management

Artificial intelligence (AI) is increasingly being applied to various aspects of healthcare, including hemoglobin management:

1. AI-powered analysis of blood test results for early detection of abnormalities
2. Predictive models for identifying individuals at risk of developing hemoglobin disorders
3. Personalized treatment recommendations based on vast datasets and individual patient profiles
4. Continuous monitoring and adjustment of treatment plans using machine learning algorithms

The integration of AI technologies holds promise for more precise and efficient management of hemoglobin-related conditions, potentially leading to improved patient outcomes and quality of life.

As research in this field continues to advance, individuals with hemoglobin concerns can look forward to more sophisticated and personalized approaches to diagnosis, treatment, and ongoing management. Staying informed about these developments and maintaining open communication with healthcare providers will be key to benefiting from future advancements in hemoglobin science and medicine.

High Hemoglobin Count: Causes, Treatments

Overview

Why is Hemoglobin A1c important.

What is a high hemoglobin count?

Hemoglobin is a protein in red blood cells that helps blood carry oxygen throughout the body. (Hemoglobin contains iron, which gives blood its red color.) The hemoglobin count is an indirect measurement of the number of red blood cells in your body. When the hemoglobin count is higher than normal, it may be a sign of a health problem.

Normal hemoglobin counts are 14 to 17 gm/dL (grams per deciliter) for men and 12 to 15 gm/dL for women. Hemoglobin levels depend on many factors, including age, race, gender and the general health of the person.

Hemoglobin is usually measured as part of a complete blood count (a routine blood test), along with hematocrit (the percentage of the blood that is made up of red blood cells), to help diagnose medical conditions and learn more about the person’s health.

Symptoms and Causes

What can cause a high hemoglobin count?

Many factors can affect the hemoglobin level. Sometimes a high hemoglobin count is the result of lifestyle or a side effect of taking medication.

Medical conditions that can cause high hemoglobin levels include:

• Polycythemia vera (the bone marrow produces too many red blood cells)
• Lung diseases such as COPD, emphysema or pulmonary fibrosis (lung tissue becomes scarred)
• Heart disease, especially congenital heart disease (the baby is born with it)
• Kidney tumors
• Dehydration (from diarrhea or lack of fluids)
• Hypoxia (low blood oxygen levels)
• Carbon monoxide exposure (usually related to smoking)

Lifestyle factors that can cause a high hemoglobin count include:

• Smoking cigarettes
• Living at a high altitude
• Taking performance-enhancing drugs such as anabolic steroids (for example, synthetic testosterone) or erythropoietin

Diagnosis and Tests

What can I expect when my doctor finds a high hemoglobin count?

Doctors usually find a high hemoglobin count when conducting tests for another health issue. Your doctor may perform additional tests to determine the cause of the higher hemoglobin levels. These tests may look for conditions that cause your body to produce too many red blood cells or disorders that restrict your oxygen supply.

Management and Treatment

How is a high hemoglobin count treated?

If a medical condition is causing high hemoglobin levels, your doctor may recommend a procedure or medication to lower it.

In a procedure called a phlebotomy, a health professional inserts a needle into your vein and drains blood through a tube into a bag or container. You might need to have this procedure on a repeated basis until your hemoglobin level is close to normal.

High hemoglobin count Causes – Mayo Clinic

A high hemoglobin count occurs most commonly when your body requires an increased oxygen-carrying capacity, usually because:

1. You smoke
2. You live at a high altitude and your red blood cell production naturally increases to compensate for the lower oxygen supply there

High hemoglobin count occurs less commonly because:

1. Your red blood cell production increases to make up for chronically low blood oxygen levels due to poor heart or lung function.
2. Your bone marrow produces too many red blood cells.
3. You’ve taken drugs or hormones, most commonly erythropoietin (EPO), that stimulate red blood cell production. You’re not likely to get a high hemoglobin count from EPO given to you for chronic kidney disease. But EPO doping — getting injections to enhance athletic performance — can cause a high hemoglobin count.

If you have a high hemoglobin count without other abnormalities, it’s unlikely to indicate a related serious condition. Conditions that can cause a high hemoglobin count include:

1. Congenital heart disease in adults
2. COPD (chronic obstructive pulmonary disease) exacerbation — worsening of symptoms
3. Dehydration
4. Emphysema
5. Heart failure
6. Kidney cancer
7. Liver cancer
8. Polycythemia vera

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

• Definition
• When to see a doctor

Dec. 02, 2020

Show references

1. Hemoglobin. Lab Tests Online. https://labtestsonline.org/understanding/analytes/hemoglobin/tab/test/. Accessed Dec. 30, 2018.
2. Blood basics. American Society of Hematology. http://www.hematology.org/Patients/Basics/. Accessed Dec. 30, 2018.
3. Blood tests. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/blood-tests. Accessed Dec. 30, 2018.
4. Understanding blood counts. Leukemia & Lymphoma Society. https://www.lls.org/managing-your-cancer/lab-and-imaging-tests/understanding-blood-counts. Accessed Dec. 30, 2018.
5. Tefferi A. Clinical manifestations and diagnosis of polycythemia vera. https://www.uptodate.com/contents/search. Accessed Dec. 30, 2018.
6. Tefferi A. Diagnostic approach to the patient with polycythemia. https://www.uptodate.com/contents/search. Accessed Jan. 3, 2019.

.

Testosterone use causing erythrocytosis

CMAJ. 2017 Oct 16; 189(41): E1286–E1288.

Department of Medicine, Divisions of Internal Medicine (Cervi) and Hematology (Balitsky), McMaster University, Hamilton, Ont.

Copyright © 2017 Joule Inc. or its licensorsThis article has been cited by other articles in PMC.

KEY POINTS

• Testosterone therapy can cause secondary erythrocytosis.

• Erythrocytosis can cause symptoms of hyperviscosity, such as headache, fatigue, blurred vision and paresthesias.

• A baseline value for hematocrit should be obtained before testosterone therapy is started, and serial values should be taken at 3, 6 and 12 months after initiation of treatment.

• For symptomatic patients with a hematocrit value over 54%, testosterone should be discontinued and phlebotomy considered.

A 60-year-old man with a medical history of depression, seasonal allergies, remote appendectomy and cholecystectomy presented to the emergency department with a sudden headache. Upon examination, his blood pressure was elevated (190/112 mm Hg) and he had erythrocytosis (hemoglobin 196 [normal 130–180] g/L and hematocrit 58% [normal 40%–54%]). Results for a complete blood cell count that was obtained six months before the patient’s visit to the emergency department were normal (hemoglobin 154 g/L and hematocrit 46%). Our patient was discharged from the emergency department with a prescription for amlodipine (5 mg once daily) for management of his hypertension. After follow-up with his family physician, he was referred to our general hematology clinic for evaluation of erythrocytosis.

We noticed that the patient was using a topical formulation of testosterone at two pumps (125 mg per pump) twice daily for fatigue and perceived androgen deficiency, although his pretreatment level of total testosterone was within normal range at 17 (normal 7.6–31.4) nmol/L. He was also taking citalopram and, on occasion, lorazepam. He reported intermittent facial flushing, but he had not experienced focal neurologic deficits to suggest stroke, tinnitus, vertigo, abdominal pain, cardiac symptoms or other symptoms consistent with hyperviscosity syndrome.

There was nothing on history or physical examination to suggest a primary hematologic cause for erythrocytosis. Upon inquiry, the patient did not have constitutional symptoms, erythromelalgias (e.g., pain, redness and elevated temperature of extremities), aquagenic pruritus (e.g., itching that occurs upon contact with water, without visible lesions), or early satiety or abdominal bloating suggestive of splenomegaly. In addition, his cardiac and respiratory examinations were unremarkable. He had no risk factors for chronic hypoxia, such as a smoking history, or lung or cardiac pathology.

Results for peripheral blood testing for the JAK2 mutation, which is present in about 97% of patients with polycythemia vera,¹ were negative. Moreover, our patient’s serum erythropoietin level was inappropriately normal at 9.6 (normal 3.8–16.9) IU/L, which further supported that a secondary process was causing elevated hemoglobin and hematocrit through an erythropoietin-dependent mechanism. Renal ultrasonography to exclude the presence of an erythropoietin-secreting tumour was unremarkable.

Because of the negative result for JAK2 testing, inappropriately normal serum erythropoietin level and temporal association with onset of androgen replacement therapy in our patient, we diagnosed erythrocytosis secondary to testosterone supplementation, and we recommended that he discontinue treatment with testosterone. Because his hematocrit was 58% in the setting of new onset hypertension, we also suggested urgent phlebotomy, after which his hemoglobin level and hematocrit normalized (154 g/L and 45%, respectively) ().

Trends for hemoglobin level (red line) and hematocrit percentage (blue line) in a 65-year-old man receiving testosterone supplementation for perceived androgen deficiency. Shaded section indicates duration of time that the patient was taking testosterone, and black arrows indicate when phlebotomy was conducted. Broken black line indicates a hematocrit of 54%.

Discussion

The Canadian Men’s Health Foundation Multidisciplinary Guidelines Task Force on Testosterone Deficiency² and the American Endocrine Society³ recommend testosterone for men with symptomatic androgen deficiency and low levels of serum testosterone. Erythrocytosis is a predictable yet underrecognized effect of testosterone.^2,3

Erythrocytosis is an increase in the number of erythrocytes and is defined as a hemoglobin level above 185 g/L and hematocrit percentage over 49% in men, or 165 g/L and 48%, respectively, in women.¹ An approach to erythrocytosis includes distinguishing a primary bone marrow disorder (e.g., polycythemia vera or other myeloproliferative neoplasm) from possible secondary causes. Primary erythrocytosis is characterized by a low level of serum erythropoietin and secondary causes by normal or high erythropoietin ().

A generalized approach to erythrocytosis.⁴ EPO = erythropoietin, ESRD = end-stage renal disease, Hb = hemoglobin, Hct = hematocrit.

Secondary erythrocytoses are further subdivided into congenital and acquired. Congenital causes include germline mutations resulting in high oxygen affinity hemoglobinopathies, altered intracellular oxygen sensing pathways or enhanced erythropoietin receptor signalling. More commonly, erythrocytosis is acquired. Erythropoietin stimulation can be physiologically appropriate in the setting of chronic hypoxic states such as lung disease, heavy smoking, intracardiac shunting, hypoventilation syndromes and local renal hypoxia (e.g., in renal artery stenosis). Drugs to stimulate erythropoietin, including darbopoietin, thiazide diuretics or androgen therapy (i.e., testosterone or anabolic steroids) are also common acquired causes for erythropoiesis. Alternatively, erythropoietin secretion can be pathologic in erythropoietin-producing malignant diseases such as renal cell carcinoma, hepatocellular carcinoma and pheochromocytoma.⁴

Erythrocytosis can result in symptoms of hyperviscosity, including chest and abdominal pain, weakness, fatigue, headache, blurred vision and paresthesias. Thrombosis is also an important consequence of erythrocytosis. A 34-year follow-up of the cohort of the Framingham study found an association between higher hematocrit and risk of cardiovascular mortality and morbidity.⁵ In addition to arterial thrombosis, an association between elevated hematocrit and venous thromboembolism has been recognized among patients with primary and secondary polycythemia, and even patients with an elevated baseline hematocrit who do not meet criteria for the classical definition of erythrocytosis.⁶ Although this relation has not been investigated in prospective randomized controlled trials, the US Food and Drug Administration has warned about the risk of venous thromboembolism, heart attack and stroke in patients using testosterone products.⁷

Testosterone-induced erythrocytosis

Interestingly, exogenous testosterone was used initially as a treatment for anemia. Recent understanding of hematopoiesis shows that estradiol, an aromatized form of testosterone, is responsible for an increase in hematopoietic stem cell proliferation and survival. In addition, testosterone increases erythropoiesis by increasing iron availability via reduced hepcidin levels, a hormone responsible for iron sequestration.⁸

An American study that evaluated the effects of graded doses of testosterone on erythropoiesis found that the percentage of hematocrit started to increase within one month of the start of treatment and continued to increase after three months in a linear dose-dependent manner.⁹ The study also reported that increases in hematocrit were exaggerated in older men (60–75 years of age) versus young men (19–35 years of age). For example, 42% of men in the younger group who were taking a 125 mg dose achieved peak hematocrit percentages after 12 weeks compared with 75% in the older group.

The American practice guideline on testosterone therapy recommends against the use of testosterone in patients with hematocrit above 50% or untreated obstructive sleep apnea,³ whereas the European guideline on male hypogonadism suggests that testosterone therapy is contraindicated at a hematocrit greater than 54%. ¹⁰ Although the most recent Canadian guideline does not advise on a hematocrit threshold above which testosterone therapy should be avoided, it recommends that hematocrit be measured at baseline, three to six months and annually,² which is in keeping with the American guideline.³

In addition to monitoring of hematocrit percentage during testosterone replacement, physicians should reevaluate indications for testosterone to ensure that patients are receiving clinical benefit, warranting ongoing treatment. In addition, initiation of testosterone therapy should be limited to those patients who show both clinical and biochemical evidence of androgen deficiency to avoid complications caused by unnecessary drug exposure.^2,3

Evidence-based guidelines on the management of erythrocytosis secondary to testosterone are lacking, and current guidelines based on expert consensus are variable. At a hematocrit percentage above 54%, stopping testosterone is advised by the American guideline,³ whereas the European guideline suggests that phlebotomy should be considered at this level. ¹⁰ This hematocrit value was derived from the Framingham cohort study. If the hematocrit percentage drops to less than 50%, and no other secondary causes of erythrocytosis are found, testosterone can be restarted at lower doses.³

Although dose reduction or discontinuation may be appropriate for some patients, patients with symptoms of hyperviscosity may benefit from phlebotomy. For patients requiring ongoing testosterone treatment, transdermal formulations (with appropriate monitoring) may be a reasonable alternative to parenteral formulations, which are associated with higher hematocrit percentages.¹¹

The section Cases presents brief case reports that convey clear, practical lessons. Preference is given to common presentations of important rare conditions, and important unusual presentations of common problems. Articles start with a case presentation (500 words maximum), and a discussion of the underlying condition follows (1000 words maximum). Visual elements (e.g., tables of the differential diagnosis, clinical features or diagnostic approach) are encouraged. Consent from patients for publication of their story is a necessity. See information for authors at www.cmaj.ca.

Acknowledgements

The authors thank Drs. Mark Crowther, Deborah Siegal and Wendy Lim for their helpful comments on earlier drafts of this manuscript.

Footnotes

Competing interests: None declared.

This article has been peer reviewed.

The authors have obtained patient consent.

Contributors: Andrea Cervi and Amaris Balitsky contributed equally to the conceptual design of the case summary and discussion topics. Both authors drafted, edited and critically revised the manuscript; gave final approval of the version to be published; and agreed to be accountable for all aspects of the work.

References

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Diagnosing or Ruling Out Polycythemia Vera in Patients With Erythrocytosis – Hematology & Oncology

H&O  How is erythrocytosis defined? 

JP  Erythrocytosis is the presence of too many red blood cells. Several different parameters are used to diagnose erythrocytosis in a blood sample: the number of red blood cells, the hematocrit, and the hemoglobin concentration. Because the production of red cells is determined by the amount of oxygen delivered to tissues, it makes sense to use first the most physiologically relevant parameter—that is, the hemoglobin concentration. The hemoglobin concentration in most US locations ranges from 12 to 16 g/dL in healthy women of European descent, and from 14 to 18 g/dL in healthy men of European descent. The range is slightly lower in healthy African Americans, partly because of a high prevalence of the a-thalassemia trait in this population, which approaches 30%. 

H&O  How is polycythemia defined? 

JP  Polycythemia is a general term for the presence of too many blood cells. Erythrocytes are far more numerous than leukocytes and platelets, so the term is actually synonymous with erythrocytosis. No consensus regarding usage has ever been reached, and in each instance, the term erythrocytosis or polycythemia is used as originally described—that is, polycythemia vera, post–renal transplant erythrocytosis, Chuvash polycythemia, etc.  

A polycythemia can be classified as primary, wherein the erythroid progenitors are intrinsically hyperproliferative, or as in vitro, in which the progenitors can grow without erythropoietin, or at an erythropoietin concentration that is lower than normal. 

The primary polycythemias include polycythemia vera, which is a chronic leukemia-like condition, and primary familial and congenital polycythemia, which is due to a germline mutation of the gain-of-function erythropoietin receptor. Polycythemia vera is acquired, whereas primary familial and congenital polycythemia is dominantly inherited. 

In contrast, secondary erythrocytosis or polycythemia is caused by circulating erythropoiesis-stimulating factors, typically erythropoietin. Secondary erythrocytosis can result from smoking, heart or lung disease, high altitudes, or supplemental testosterone. Alternatively, it can be inherited, caused by mutations in genes of the hypoxia-sensing pathway or by hemoglobin variants with a high hemoglobin affinity for oxygen. In spurious polycythemia, the red cell mass in the body is normal but the plasma level is decreased. The accompanying high hemoglobin concentration and hematocrit create the false impression that too many red cells are present. This situation typically occurs when a person becomes dehydrated and the plasma volume decreases. One form of spurious polycythemia is Gaisböck syndrome, which occurs primarily in obese men. Theories abound regarding the causes of Gaisböck syndrome, but they have not been definitively established. 

H&O  How do hematologists go about determining the presence of erythrocytosis in a particular patient?

JP  The measurements that we typically use to determine the presence of polycythemia are limited by the fact that we take only a small sample of blood. From this single sample, we can measure the following: (1) the relative proportions of blood cells (mainly red cells) and plasma—that is, the hematocrit; (2) the hemoglobin concentration in the blood; and (3) the red blood cell count. We do not, however, learn from these measurements how much red cell mass is in the body overall. A technique for measuring the number of red blood cells in the body that was used routinely earlier in my career involved taking a blood sample and adding a radioactive marker to the red cells and a separate marker to the plasma (labeled albumin), thus labeling both of these blood components. Following the in vitro manipulation, the blood sample was injected back into the patient’s body. From the degree of dilution of the 2 markers, we could calculate the red cell mass and plasma volume per kilogram of body weight, which allowed us to differentiate between true polycythemia and spurious polycythemia. The procedure also allowed us to unmask hidden polycythemia, in which an increased red cell mass is present but is diluted in the blood by a concomitant increase of plasma. The technique produced more accurate information than currently available tests do, but unfortunately it is no longer widely available in the United States.

When I see a patient with elevated hemoglobin, my next step is to take a medical and family history. Differentiating between acquired and congenital polycythemia and between sporadic and familial polycythemia requires a time-consuming evaluation. Complicating matters is that polycythemia vera is always acquired, arising from a somatic mutation, but well-documented clusters of cases of polycythemia vera in families do exist. In certain instances, a patient with polycythemia vera may have some relatives with the same condition and other relatives with related but different myeloproliferative disorders, such as essential thrombocythemia or primary myelofibrosis, yet the conditions are all acquired rather than congenital. This finding suggests the existence of a not-yet-defined familial genetic predisposition to somatic mutations that lead to the development of these disorders. 

H&O  What are the symptoms of erythrocytosis? 

JP  The symptoms are hugely variable, depending on the cause. Erythrocytosis may cause no symptoms at all, or it may be highly symptomatic and detrimental to health. The symptoms of polycythemia vera may or may not be present. When they do occur they are quite specific, and include aquagenic pruritus, erythromelalgia, symptoms of arterial or venous thromboses, and gout. In addition, the risk for transformation to myelofibrosis in patients who have polycythemia vera is approximately 15%; in such cases, they present with fatigue, bone pain, sweating, and symptoms of splenomegaly, such as early satiety and/or splenic pain. The risk for transformation to acute leukemia is lower, at 3% to 5%, in which case the symptoms are the same as those in any acute leukemia. 

A different set of symptoms is seen in patients who have an increased number of red cells because of an underlying pheochromocytoma, cerebellar or ophthalmic hemangioblastoma, or renal cancer; these patients have tumor-specific symptoms that are not the same as those of erythrocytosis. Resection of the tumor can resolve the condition. 

Symptoms of other polycythemias/erythrocytoses are nonspecific, with most patients who have an increased number of red cells experiencing no symptoms. Rare patients may have symptoms such as fatigue and headaches resulting from hyperviscosity; these symptoms should resolve with phlebotomy.

Blood clots are the major complication in patients with polycythemia vera, and blood clots are even more common in those with Chuvash polycythemia. Common dogma dictates that a high hematocrit is the cause of blood thickening and blood clots, but I am skeptical that this is the major cause. No evidence exists that a high hematocrit is harmful and a direct cause of thrombosis; in addition, many conditions that lead to a very high hematocrit are not associated with thromboses. These include Eisenmenger complex, testosterone-induced erythrocytosis, and erythrocytosis resulting from a high hemoglobin affinity for oxygen. Growing evidence now indicates that other factors in polycythemia vera and Chuvash polycythemia contribute to blood clots. The best single blood cell parameter that correlates with thrombosis in polycythemia vera is the leukocyte count. 

H&O  How do hematologists go about determining the cause of erythrocytosis in a particular patient? 

JP  The first step is to determine how long the patient has had the condition. Does the red cell elevation go back to childhood? If so, the condition is likely congenital. Of course, it is often impossible to determine how long the elevation has been present because it may be that the patient’s hemoglobin level is being tested for the first time in adulthood.

The next step is to address the family history. If erythrocytosis affects just one of the patient’s parents and about half of the patient’s siblings, the condition is likely dominantly inherited. If neither parent is affected but the patient has multiple siblings and approximately half of the siblings are affected, the condition is likely autosomal recessive. This information helps to narrow the diagnosis.  

In cases of acquired erythrocytosis, I first look carefully at the pulmonary function. Is lung disease present? Is the patient a smoker? We measure arterial blood gases and how much oxygen is bound to hemoglobin. We also measure carboxyhemoglobin because it is possible even for nonsmokers to have elevated carbon monoxide levels if they have a garage that is contaminated with car exhaust fumes or use equipment that is contaminated with carbon monoxide. Another form of hemoglobin is methemoglobin, in which the iron is in the ferric state rather than in the normal ferrous state; methemoglobin does not deliver oxygen to tissues. Methemoglobinemia can be either congenital or acquired. Both carboxyhemoglobin and methemoglobin bind oxygen so tightly that they are useless as oxygen carriers. All these conditions are either confirmed or ruled out by arterial blood gas testing. However, polycythemia vera may develop even in a smoker with pulmonary hypoxia and carboxyhemoglobinemia. When the clinician is in doubt, the presence of a JAK2 mutation confirms the diagnosis of coexisting polycythemia vera.

If I am able to exclude arterial hypoxia, elevated carbon monoxide, and methemoglobinemia, I measure the erythropoietin level. This is generally low in polycythemia vera and even lower in primary familial and congenital polycythemia. If the erythropoietin level is high, or is inappropriately normal when the hemoglobin concentration is high, the patient may have a tumor that produces erythropoietin, or an abnormality in which the blood supply to the kidney tissue is inadequate and the tissue begins to produce erythropoietin. 

If the subject has an inherited condition, it is possible that the patient was born with abnormal hemoglobin that binds oxygen too tightly, or even more rarely with low levels of 2,3-diphosphoglycerate (DPG) in red cells resulting from a congenital disorder of 2,3-DPG synthesis. Because less oxygen is released into the tissues from hemoglobin, the body compensates for the oxygen deficiency by increasing erythropoiesis until sufficient oxygen is delivered to the tissues. Phlebotomy is counterproductive in these patients, inevitably causes iron deficiency, and further elevates the erythropoietin level. The test to identify congenital forms of erythrocytosis is measurement of the hemoglobin-oxygen dissociation curve. If this curve is left-shifted (low P₅₀), the patient has a high-oxygen-affinity hemoglobin mutant; if it is right-shifted (high P₅₀), the patient has a low-oxygen-affinity hemoglobin mutant and the hemoglobin concentration may be decreased. If the instrument for measuring the hemoglobin-oxygen dissociation curve is not available, one can estimate the hemoglobin affinity for oxygen by measuring the partial pressure of oxygen, the oxygen saturation of hemoglobin, and the pH from venous blood gases, not arterial blood gases.

Other causes of congenital erythrocytosis with increased or inappropriately normal erythropoietin levels are inherited disorders of hypoxia sensing, in which a mutation in the hypoxia-inducible pathway that regulates erythropoietin production causes the body to increase red cell production. Hypoxia-inducible factors (HIFs; the 2 best-understood isoforms are HIF-1 and HIF-2) are master transcription factors that regulate multiple genes, including the erythropoietin gene. Patients with increased HIFs produce too much erythropoietin, which leads to the production of too many red cells. Increased HIFs can be caused by mutations resulting from loss of function of HIF negative regulators. The result is Chuvash polycythemia, caused by an alteration in the von Hippel-Lindau (VHL) gene or a prolyl hydroxylase mutation. Other mutations are from gain of function of HIF-2a, the principal regulator of erythropoietin production. 

H&O  Now that we have the ability to measure erythropoietin levels and test for JAK2 mutations, do physicians still need to measure red cell and plasma volume? 

JP  I agree that the availability of JAK2 mutation testing enables a specific diagnosis of polycythemia vera in most patients rapidly and accurately. However, as previously discussed, occasional cases of spurious polycythemia or hidden polycythemia cannot be diagnosed with a routine blood cell count. Measurement of the red cell and plasma volume is not available in most medical centers in the United States because of what I consider to be an exaggerated concern about radioactivity. The test does require the use of radioactive chromium, but the amount of radiation is very small—comparable to the natural radioactivity that a person is exposed to on a long airplane flight. 

Fortunately, it is faster and easier to test for JAK2 mutations when patients have elevated levels of red cells. Virtually all patients with polycythemia vera—approximately 99%—have this somatic mutation, which increases the production of red cells and sometimes platelets and neutrophils as well. 

H&O  Are any causes of secondary polycythemia known besides high altitude, smoking, heart disease, lung disease, and testosterone? 

JP  We used to think that sleep apnea was a cause, which makes sense because someone who stops breathing at night would produce more erythropoietin—at least in theory. The evidence does not support this association, however. Some patients develop polycythemia after kidney transplant, which is known as post-transplant erythrocytosis. Patients may develop increased levels of cobalt and manganese, or tumors that secrete erythropoietin. Some patients engage in surreptitious doping with erythropoietin.

H&O  Do you treat symptoms of severe iron deficiency in phlebotomized patients with polycythemia? 

JP  Yes, I absolutely do. We have a lot of evidence indicating that ignoring iron deficiency is bad medicine. Hemoglobin requires iron, as do the muscles, the brain, and all other tissues. In addition, iron is essential for the degradation of HIF (iron is a cofactor of HIF’s principal negative regulators; ie, prolyl hydroxylases), and so iron deficiency further increases erythropoietin production and erythropoiesis. If someone who has pulmonary hypertension and too many red cells in a high-altitude environment (chronic mountain sickness) is treated with phlebotomy, we have created iron deficiency and worsened the pulmonary hypertension. I believe that always using phlebotomy to treat all forms of polycythemia is misguided and can even be harmful. It can improve the laboratory test results, such as the hemoglobin level, which makes us physicians feel better but is bad for the patients. If symptomatic iron deficiency develops in a patient following phlebotomy, we can address that with a short course of oral iron supplementation, and the patient will usually experience an immediate decrease in fatigue and improvement in quality of life. I generally prefer to normalize the blood cell counts in polycythemia vera with hydroxyurea or another treatment. The 2 other options currently available are pegylated interferon and the JAK2 inhibitor ruxolitinib (Jakafi, Incyte). No proven therapy exists for congenital disorders of hypoxia sensing or high hemoglobin affinity for oxygen.

H&O  Could you explain the mechanisms of Chuvash polycythemia and what it has taught us about erythropoiesis?

JP  This syndrome was first described among people of Asian origin living in a European area of Russia, the Chuvash Autonomous Soviet Socialist Republic; however, it is present worldwide, with another area of endemicity in the Italian island of Ischia. Chuvash polycythemia is caused by a germline mutation in the VHL gene that is inherited in an autosomal-recessive manner from both parents. This disorder of hypoxia sensing, the first to be described, results from a loss-of-function mutation in a negative regulator of HIFs, the VHL gene. HIFs have 2 subunits; either HIF-1a or HIF-2a combines with HIF-b to form either an HIF-1 or HIF-2 dimer. Only intact HIF dimers have function. In the presence of oxygen, the subunits of HIF-a undergo prolyl hydroxylation by prolyl hydroxylase; to function, this enzyme requires the presence of iron and it is inhibited by cobalt and manganese. Hydroxylation of the proline in the subunits of HIF-a changes the configuration of these proteins, which then bind to the von Hippel-Lindau protein, resulting in their ubiquitination and rapid proteasomal degradation. Thus, people with Chuvash polycythemia have a congenital defect leading to high HIF levels and thus the production of excessive amounts of erythropoietin.

Intriguingly, other VHL mutations cause tumor predisposition syndrome, whereas the Chuvash VHL mutation causes congenital polycythemia, but not tumors. This mutation not only results in a very high level of HIF and increased erythropoietin (secondary erythrocytosis) but also causes erythroid progenitor hypersensitivity to erythropoietin, a feature of primary polycythemia. The morbidity and mortality of Chuvash polycythemia result principally from an increased occurrence of thrombosis that is not relieved and is even increased by phlebotomy; however, the cause is not the high hematocrit but too much HIF, which dysregulates genes in the thrombotic pathway (protein S, tissue factor, thrombospondin 1, and likely others).

A least 2 other disorders in addition to Chuvash polycythemia are congenital disorders of hypoxia sensing—caused by an HIF-2a (encoded by the EPAS1 gene) mutation. The same molecular and pathophysiologic defects associated with the inherited EGLN1 mutation (encoding prolyl hydroxylase 2) can also be acquired from cobalt and manganese poisoning, as well as iron deficiency. These conditions block the activity of prolyl hydroxylase and increase HIFs. 

Disclosure

Dr Prchal has no conflicts to declare.

Suggested Readings

Ang SO, Chen H, Hirota K, et al. Disruption of oxygen homeostasis underlies congenital Chuvash polycythemia. Nat Genet. 2002;32(4):614-621.

Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016; 127:2391-2405.

Perrotta S, Nobili B, Ferraro M, et al. Von Hippel-Lindau-dependent polycythemia is endemic on the island of Ischia: identification of a novel cluster. Blood. 2006;107(2):514-519.

Pilli VS, Datta A, Afreen S, Catalano D, Szabo G, Majumder R. Hypoxia downregulates protein S expression. Blood. 2018;132(4):452-455.

Prchal JT, Prchal JF. Polycythemia vera. Chapter 84. In: Kaushansky K, Lichtman MA, Prchal JT, et al, eds. Williams Hematology. 9th ed. New York, NY: McGraw Hill Medical; 2015:1291-1306.

Prchal JT. Primary and secondary erythrocytosis. Chapter 57. In: Kaushansky K, Lichtman MA, Prchal JT, et al, eds. Williams Hematology. 9th ed. New York, NY: McGraw Hill Medical; 2015.

Reeves BN, Song J, Kim SJ, et al. Upregulation of tissue factor may contribute to thrombosis in PV and ET. Paper presented at: 60th Annual Meeting of the American Society of Hematology; December 1-4, 2018; San Diego, CA. Abstract 2513.

Sergueeva A, Miasnikova G, Shah BN, et al. Prospective study of thrombosis and thrombospondin-1 expression in Chuvash polycythemia. Haematologica. 2017;102(5):e166-e169.

Erythrocytosis – an overview | ScienceDirect Topics

■ Erythrocytosis

Erythrocytosis, which is an increase in the concentration of RBCs and Hb in the blood, can result from either an absolute increase in red cell mass (a.k.a. absolute erythrocytosis or “polycythemia”) or from a decrease in plasma volume (relative erythrocytosis). Erythrocytosis in which the concentration of RBCs is increased with little or no anemia can also occur in microcytic RBC states, most notably thalassemia minor or trait. However, this type of erythrocytosis is a consequence of the microcytosis and is not associated with an increased Hb concentration and is not discussed further in this text.

Relative erythrocytosis generally results from hemoconcentration due to decreased fluid intake and/or marked loss of body fluids. A contraction of plasma volume produces the appearance of erythrocytosis without any actual increase in the body red cell mass. A chronic form of relative polycythemia (Gaisböck’s disease) is an obscure syndrome of uncertain cause.

Absolute erythrocytosis or polycythemia can be either primary or secondary. Primary erythrocytosis can be either congenital or acquired. The congenital form, primary familial polycythemia, is a consequence of mutations in the erythropoietin receptor (EPOR) that confer hypersensitivity to erythropoietin. Acquired absolute erythrocytosis, termed polycythemia vera, is a clonal stem cell disorder that belongs to the group of chronic myeloproliferative neoplasms. This disease is associated with an increase in all myeloid cell lines, but its primary clinical manifestations relate to erythrocytosis. This disorder is discussed in detail in Chapter 17. Secondary erythrocytosis is a consequence of increased erythropoietin resulting from one of several causes. Chronic hypoxia, caused by cardiac or pulmonary disease, sleep apnea, or residence at high altitude, results in a compensatory erythrocytosis. Certain abnormal Hbs, such as inherited high oxygen affinity variants or increased carboxyhemoglobin in smokers, fail to deliver oxygen to the tissues effectively and also result in a compensatory increase in erythropoietin production by the kidneys. Some patients may have aberrant erythropoietin production by neoplasms. Finally, there are rare congenital forms of secondary polycythemia other than those due to abnormal Hbs. For example, Chuvash polycythemia is due to a germline von Hippel–Lindau gene (VHL) mutation (R200W). The gene product is involved in regulation of cellular levels of hypoxia inducible factor alpha (HIF-α) subunits involved in the oxygene sensing pathway. The mutation results in elevated HIF1-α leading to elevated levels of erythropoietin and an augmented response to erythropoietin. Thus investigation for erythrocytosis includes a complete review of a patient’s clinical history and CBC values. A normal or elevated erythropoietin (EPO) level is suggestive of a secondary cause of erythrocytosis. Analysis for JAK2 mutation is important for the evaluation of polycythemia vera since only very rare cases (<1%) lack a JAK2 mutation. For patients with clinical suspicion of congenital erythrocytosis, mutational analyses are becoming available as confirmatory tests.

What Your Veterinarian Means When They Talk About Your Dog’s CBC

April 1, 2016 – A complete blood count is one part of the blood work included in your dog’s Golden Retriever Lifetime Study annual study examination and also if your dog gets sick. What does the CBC tell your veterinarian about your dog? At the simplest level, the CBC shows how many red blood cells (cells that carry oxygen from lungs to tissues), white blood cells (cells responsible for fighting infection), and platelets (cells that help form blood clots) are circulating in your dog’s blood at the time of measurement, but we can get more detailed information from this series of tests.

Let’s start with tests that relate to red blood cells:

• Red blood cells: RBC is a reflection of the number of cells circulating. If it is low, it indicates that your dog has anemia and, depending on the situation, additional diagnostics may be needed to find out why. If this number is too high, it usually indicates that your dog is dehydrated, although there are rare diseases that can cause a high red cell count in the absence of dehydration.
• Hemoglobin: HGB is the protein molecule inside red blood cells that carries (or binds) oxygen and carbon dioxide. Depending on where you live, hemoglobin levels will vary. The higher the altitude, the higher the hemoglobin level. Low hemoglobin levels also indicate anemia.
• Hematocrit: this reflects what percent of your dog’s total blood volume is taken up by red blood cells. It is another indicator of anemia and dehydration. This test is often a go-to in emergency situations because it is easy and fast to run in the clinic and can quickly tell us a lot about the health of your dog.
• Mean corpuscular volume: the MCV tells us the size of your dog’s red blood cells. It is useful because younger red blood cells are larger than mature red cells. If this number is high, it indicates red cells are turning over faster than expected. This can be due to bleeding or certain types of anemia.
• Mean corpuscular hemoglobin concentration: MCHC is calculated from the hemoglobin and hematocrit numbers, and tells average concentration of hemoglobin per red blood cell. It’s a tool used to determine what kind of anemia might be present.

Turning to white blood cells, or leukocytes, the differential count identifies what types of leukocytes are present, which gives your veterinarian an indication of the source of any inflammation. In the differential count, we get two measures for each cell type – a percentage and an absolute count. Percentages indicate if the ratio of different cell types is normal. Absolute counts indicate the degree to which each cell count is too high or too low. Typically, white blood cells are elevated when infection is present and can be decreased in certain disease processes or when some drugs are given, like chemotherapeutic agents. Specific types of cells are:

• Granulocytes belong to the branch of the immune system called the innate system. The innate system is in place and ready to respond to infection, but isn’t very sophisticated in its approach (like a sledge hammer).
• Neutrophils: these cells are the most common type of granulocyte and are elevated when infection is present. Their job is to go to the site of infection and kill everything in their path. In addition, they secrete proteins called cytokines to attract other components of the immune system. 
• Band cells: these immature neutrophils, when their levels are elevated, indicate there is infection severe enough to quickly deplete mature neutrophils and the bone marrow is sending out young cells to replace the loss.
• Eosinophils: these cells typically are elevated when an internal parasitic infection is present (such as heartworms). They also are elevated in pathological immune responses such as asthma and allergic reactions.
• Basophils: these are the rarest type of granulocyte and usually are associated with ectoparasitic infections (such as mites or lice). They contain histamine, which is part of the allergic process.
• Monocytes also are part of the innate immune system. They go to sites of infection to kill pathogens, present antigens to lymphocytes (part of the immune system’s learning process), and produce cytokines (chemicals that attract the rest of the immune system). Once at a site of infection, they differentiate into one of two kinds of cells: macrophages (“big eaters”) and dendritic cells (cells with feet). Monocytes are elevated in many conditions, including infection, stress, some hormonal disease processes, and immune-mediated diseases.
• Lymphocytes are part of the ‘learned’ immune system because they generate antibodies in response to previous exposure, either through natural infection or vaccination. Lymphocytes are much more specific than the cells discussed above, but they also are slower to respond to infection. They can be elevated when certain types of infection are present and also with certain types of cancer. When they are low, it may indicate a disease process that is causing immune compromise.

Finally, we have platelets:

• Platelets are cells involved in causing blood to clot following injury. Low platelet counts may indicate certain autoimmune diseases or fulminant systemic disease.

Following each study examination, laboratory results are shared with participating veterinarians online at caninelifetimehealth.org under the “Lab Results” tab of the patient’s record. All lab results are interpreted by your veterinarian in the context of your dog’s clinical signs and symptoms. If you are concerned or have questions about your dog’s results, please talk with your veterinarian

Blood counts and sickle cell disease

What are blood counts?

Blood is made up of cells in a liquid called plasma. Blood cells are made in the bone marrow (the soft center of the bones). Then they are released into the body to do their jobs. The body has 3 main types of blood cells: red blood cells, white blood cells, and platelets. Sickle cell disease mainly affects the red blood cells, but can sometimes affect other blood cells. Medicines for sickle cell disease can also affect blood cells.  

If your child has sickle cell disease, counting and studying blood cells can tell the St. Jude staff about your child’s disease and how to treat it. A complete blood count (CBC) is a test that tells your child’s doctor about all 3 types of blood cells: red blood cells, platelets, and white blood cells.

Red blood cells

The main purpose of red blood cells is to deliver oxygen to the body. The part of the blood that carries oxygen is called hemoglobin. People with sickle cell disease have abnormal hemoglobin, called sickle hemoglobin or hemoglobin S. If your child has sickle cell disease, her red blood cells do not last as long because the sickle hemoglobin damages them. This means your child has fewer red blood cells than normal, a condition called anemia. People with normal hemoglobin usually have a hemoglobin level around 12 g/dL. People with sickle cell disease have lower hemoglobin levels, usually between 6–11 g/dL. The exact level may be different depending on the type of sickle cell disease and the person. It is important to know your child’s usual hemoglobin level. Blood tests done over a period of time will tell the doctor what is normal for your child. 

Reticulocyte count

A reticulocyte is a young red blood cell that is forming in the bone marrow. Normally, reticulocytes stay in the bone marrow until they develop into red blood cells and enter the blood. The reticulocyte count is a test that measures the number of reticulocytes in the blood. For most people, the number is very low because most reticulocytes stay in the bone marrow. If your child has sickle cell disease, she may have a higher reticulocyte count. This is because your child’s body has to make more red blood cells due to anemia. A normal amount of reticulocytes in the blood is between 0.45–1.8 percent. If your child has sickle cell disease, she may have a reticulocyte count of 2–3 percent or more.  The number of reticulocytes is different for each person with sickle cell disease.  If your child’s reticulocyte count drops very much, it might mean her body is making fewer red blood cells. This could be dangerous. The St. Jude staff will test your child’s reticulocyte count at each clinic visit.

White blood cells

White blood cells help the body fight infection. A normal white blood cell count is 5,000–10,000/mm3. When the white blood cell count is low, it is easier to get an infection and harder to get over it. If your child has sickle cell disease, her white blood cell count will usually be normal or higher than normal. However, illness and some medicines can make the white blood cell count go up or down for a short time.  

Neutropenia

A neutrophil is a type of white blood cell that kills bacteria. Neutrophils help prevent infection.  If your child does not have enough neutrophils, this is called neutropenia.  Children taking hydroxyurea for sickle cell disease often have mild neutropenia. If your child is taking hydroxyurea, the St. Jude staff will keep track of your child’s neutrophil count.

The doctor will use a measurement called the Absolute Neutrophil Count (ANC) to keep track of your child’s neutrophils. The ANC shows how well the body can fight infections, especially bacterial infections.

Platelets

Platelets are blood cells that help stop bleeding by making the blood clot. A normal platelet count is 150,000 to 400,000/mm3. If your child has a low platelet count, she may bruise or bleed more easily. Normally, sickle cell disease does not cause low platelet levels.

Keeping track of your child’s blood counts

If your child has sickle cell disease, the St. Jude staff will keep track of her blood counts. Your child will usually have a complete blood count (CBC) and reticulocyte count at each clinic visit. The doctor will tell you if your child needs more blood tests. Keeping track of your child’s blood counts is an important part of treatment. The St. Jude staff will review the test results with you and give you a copy each time your child sees the doctor. You should keep these results with your child’s medical records.

Questions?

If you have questions about your child’s blood counts or what they mean, ask the doctor or nurse. If you are outside the hospital, refer to your Important Phone Number Card. You may also call the St. Jude operator at (901) 595-3300 or toll-free 1-866-2STJUDE (1-866-278-5833) and ask for your child’s nurse case manager.

90,000 Complete blood count. How it is carried out and what shows

General analysis of blood (CBC) is the most accessible method of initial assessment of the state of the body, the results of which, along with general urine analysis and biochemical blood analysis, are included in the algorithms for diagnosing most diseases. In a healthy person, blood is relatively constant in composition, but it reacts to almost any pathological changes in the body. Therefore, in order to understand what is happening to a person, what studies to prescribe in the future or to decide on the treatment, the doctor, first of all, always prescribes a CBC.

This study is also used as a preventive examination even in the absence of any symptoms and reflects changes in health conditions. In addition, the UAC allows you to assess the success of the treatment.

Normal values ​​of indicators UAC

Explanation of the main indicators of a general blood test:

Blood is a type of tissue of the human body, consisting of a liquid part (plasma) and shaped elements (cells) and performing a huge number of different functions such as transporting oxygen and carbon dioxide, maintaining a constant body temperature, stopping bleeding, neutralizing pathogenic agents and etc.

The changes observed in the blood are most often uncharacteristic for a particular disease, but at the same time reflect the general state of the organism.

Fluctuations in general blood count indicators can also occur in normal conditions, under the influence of various factors: food intake, physical activity, emotional stress, pregnancy, smoking, etc. So, in pregnant women, the number of red blood cells and hemoglobin normally decreases. The white blood cell count, in turn, can rise after eating, exercising, or prolonged exposure to the sun.

In what cases is a general blood test prescribed?

Most often, the doctor prescribes a general blood test in order to assess the levels of hemoglobin, erythrocytes, platelets, ESR, the number of leukocytes and the leukocyte formula.

So, for example, if there are signs of infection, a complete blood count will help to understand the nature of the pathogen: viral or bacterial. In particular, a viral infection is characterized by an increase in the level of lymphocytes, and for a bacterial infection – neutrophils.

Also in the general blood test, the number of erythrocytes, hemoglobin and hematocrit is determined.These indicators allow you to identify and assess the severity of anemia, as well as to suggest the cause of its occurrence.

Platelets

Another important indicator is platelets. These small cells are directly involved in blood clotting processes. If the platelet count is low, the risk of bleeding and bruising increases. In a situation where there are many platelets, the likelihood of blood clots and, as a result, vascular blockage increases.

ESR

The erythrocyte sedimentation rate (ESR) is a measure of how quickly blood in a test tube separates into plasma and cells.The main factor affecting this ESR is the protein composition of the blood, which, in turn, changes in various physiological (pregnancy, menstruation) and pathological (inflammation, infection) conditions. Together with other blood parameters, ESR has a prognostic value and can serve as an indicator of the effectiveness of the treatment. At the same time, an increase in ESR is not a specific indicator of any disease and does not directly correlate with the dynamics of the disease that has arisen. This is due to the fact that from the onset of the disease it can take from 24 to 48 hours before the ESR value goes beyond the normal range, as well as the fact that ESR can remain at a high level for up to several months even after the symptoms disappear.

There are automated and manual methods for determining ESR. Different laboratories may use different methods, which is why it is important to understand that ESR results from different laboratories can be similar only with normal ESR values. If the ESR is above the norm, then the analysis data may be incomparable, even if the study was carried out at the same time. The higher the ESR level, the greater the difference between the results obtained using different methods. For the correct interpretation of the tests, experts advise taking tests always in the same laboratory.

Where to take a general blood test?

In the Sinevo medical laboratory a general blood test is performed from venous (through a puncture of a vein) and capillary (puncture of a finger) blood.

Vein blood is the “gold standard” biological material for a complete blood count and is preferred. The fact is that, unlike venous blood, capillary blood is a mixture of blood from small arteries, veins and capillaries, contains intercellular fluid, remnants of destroyed cells, lymph, which can affect the analysis result.

You can take a general blood test (CBC) in Minsk, Baranovichi, Bobruisk, Borisov, Brest, Vitebsk, Gantsevichi, Gomel, Grodno, Zhlobin, Lida, Mogilev, Mozyr, Molodechno, Novogrudok, Novopolotsk, Orsha Rechitsa, Svetlogorsk, Slutsk, Smorgon, Soligorsk.

In some cases, capillary blood donation is still recommended: with a tendency to venous thrombosis, overweight and difficult access to veins, extensive burns, in young children.

It is important to remember that only a doctor can correctly interpret changes in the research results, recommend additional diagnostic methods, including laboratory ones, to clarify the existing blood picture, prescribe effective treatment and prevention methods. Do not engage in self-diagnostics, seek help from a specialist!

Tel Aviv Medical Center | Decoding of the clinical blood test

This type of blood test provides complete information about all blood cells, their number, characteristics (mainly size and shape).

This data can be used to diagnose the following medical problems:

• Vitamin B12 deficiency anemia
• Red blood cell deficiency
• iron deficiency
• various infections (with a bacterial infection, a large number of neutrophils appear, with a viral infection, a larger number of lymphocytes will appear, with a parasitic infection – eosinophils.)

Of course, you can get a picture of various malignant blood diseases (for example, with lymphoma, more lymphocytes appear).

Types of blood cells in the test:

1. White blood cells (WBC)

Leukocytes belong to the body’s defense system. They take on part of the fight against various infections, such as bacteria, viruses, fungi, parasites.

The body’s defense system and white blood cells are also involved in the treatment of cancer-infected cells.

There are several types of white blood cells. Each group of cells has a specific function in the body’s defense.An increase in the number of leukocytes in one of the groups indicates the type of infection that affects the body.

Also, in a malignant disease of blood cells, an increase in the number of leukocytes of one of the groups is detected.

Normal white blood cell count: 4300-10800.

An increased number of cells is called leukocytosis, which usually indicates an infection. A decreased cell count is called leukopenia. This condition can indicate problems of the body’s defense system for various reasons (blood cancer – leukemia, side effects of medications).

Leukocytes are subdivided into several groups. Each group has its own function (differential) – the differential. An increase in the number of cells in one of the groups tells us about the type of infection that has affected the body.

Neutrophils – Neutrophil , the largest group of leukocytes. These cells are responsible for treating bacterial infections. Normal: 28-54% of the total white blood cell (WBC) count.

An increased number of neutrophils is called neutrophilia (also called left shift).In most cases, this means that the body is fighting a bacterial infection. It can also indicate blood cancer.

Low neutrophil count – neutropenia. It may indicate that the body has been infected with bacterial infections. It can also indicate the presence of blood cancer.

Lymphocytes – Lymphocytes (Lymph) , responsible for the treatment of viral or long-term bacterial infections. Normal: 36-52% of the total white blood cell count (WBC).

An increased number of these cells – lymphocytosis. May indicate a viral infection, a chronic bacterial infection, or a blood cancer called lymphoma.

Low count – lymphopenia. May indicate damage to the bone marrow, where various blood cells are formed. The causes of leukopenia can be different: side effects of drugs, cancer, some viral infections, AIDS.

Monocytes – Monocytes (Mono) , responsible for the body’s resistance to viral, fungal and bacterial infections.In the case of mononucleosis, monocytes take on an atypical form, they are called atypical monocytes. Normal: 2-9% of total white blood cells (WBC).

Increased number – monocytosis. It appears with certain bacterial infections (tuberculosis, syphilis), viral and parasitic infections. Monocytosis can also indicate cancer.

Basophiles – Basophiles (Baso) , the rarest immune blood cells responsible for allergic processes.

Normal: 0-1% of total white blood cells (WBC). An increased amount of them indicates an allergic reaction or a predisposition to allergies.

Eosinophils – Eosinophles (Eos) , leukocyte blood cells involved in various processes in: infections, allergic reactions, asthma, connective tissue diseases, systemic lupus erythematosus (lupus), psoriasis.

Normal: 1-3% of total white blood cell count (WBC).

An increased amount appears during an asthma attack, an active allergic process, and scabies.

Red blood cells (RBC) – red blood cells, cells are responsible for delivering oxygen and removing carbon dioxide from various parts of the body. Red blood cells bind oxygen in the lungs and, using arterial blood flow, bring oxygen to all tissues of the body. Oxygen is released in the tissues of the body and blood cells bind carbon dioxide.The venous blood flow brings cells to the lungs, in which red blood cells release carbon dioxide and re-bind to oxygen.

Normal amount: 4.5-5.3

An increased number of red blood cells appears in various diseases of the blood system. Smoking and lung disease increase the number of red blood cells.

A reduced red blood cell count is called anemia. Possible causes of anemia: bleeding, impaired blood formation, lack of vitamin B12.

Hematocrit – Hematocrit (HCT) – blood count. The rate for men: 54-37%, for women: 47-33%

This is the volume occupied by red blood cells in the blood plasma.

Red Blood Cell Volume – Mean Corpuscular Volume (MCV) , normal size: 78-93.

A high level is called macrocytosis. May be caused by a lack of vitamin B12.

Low level – microcytosis. May be caused by iron deficiency.

Mean Corpuscular Hemoglobin (MCH) .

Rate: 24-30.

Low levels occur with anemia or other circulatory system disorders.

Hemoglobin – Hemoglobin (Hb) , a protein responsible for binding oxygen and carbon dioxide in red blood cells. The norm for men: 12-18 mg / dl, for women: 12-16 mg / dl. Low hemoglobin levels – anemia. It can be caused by bleeding, lack of iron, lack of vitamin B12, and there can be a violation of hematopoiesis of red blood cells.

Segmentation of red blood cells – RDW , measurement of the identity of the size of red blood cells.Different cell sizes may indicate a recovery from anemia or an abnormal red blood cell production. Normal sizes: 14.5-11.5%.

Ferritin – Ferritin , an iron-binding protein complex, is used to store iron in the body.

Norm for men: 12-300 nanograms per milliliter. Norm for women: 12-150 nanograms per milliliter.

A low level indicates iron deficiency anemia.

Transferrin – Transferin , protein – used to transfer iron in the body.

Norm: 200-400 mg / dl. A low level indicates a disturbance in the circulatory system.

Platelets – Platelets – (PLT) , cell fragments responsible for one of the stages of blood clotting.

Damage to the vessel wall causes a concentration of platelets at the site of injury. The platelets break down and release various clotting factors that promote clotting and stop bleeding.Norm: 1500000-450000. An increased amount appears due to inflammation, bone marrow diseases, or due to acute bleeding. Elevated platelet counts can cause increased blood clotting. A reduced level appears due to the defeat of the formation of platelets in the bone marrow or their increased destruction. A low platelet count can lead to bleeding tendencies.

2. The amount of fat in the blood

The adipose tissue of the body is used as the main store of energy in the body.Blood contains various fats as part of the processing and storage of food. The level of fats in the blood indicates the balance of fats in the body and affects the development of many diseases of various organs (such as the heart, blood vessels, inflammation of the pancreas). To obtain accurate results, the study of the amount of fat in the blood is checked on an empty stomach 10-12 hours after the last meal.

Triglycerides – riglycerides , fat mainly from food.

Rate: 10-190 milligrams per deciliter. An increased level is usually caused by an increased intake of dietary fat. It can be increased in diseases such as cirrhosis of the liver, decreased thyroid function, inflammation of the pancreas. Decreased levels may indicate impaired fat absorption or increased thyroid function.

Total cholesterol – Total Cholesterol , is essential for the vital functions of the body and is used as an important component in the structure of the cell wall.It is mainly formed in the liver. It is used to form various hormones and fat-soluble vitamins (A, D, E, K).

Rate: Up to 200 milligrams per deciliter.

An elevated level indicates an increased intake of dietary fat or an increased production of cholesterol in the body, which is a high risk factor for heart disease and vascular sclerosis. Low cholesterol levels are associated with inadequate nutrition or decreased absorption of food.It can also be associated with decreased thyroid function, liver disease, chronic praise.

Good Cholesterol – HDL , a molecule whose function is to collect residual cholesterol in the body and carry it to the liver. In the liver, fat is stored and thus not deposited on the walls of blood vessels. Therefore it is called good cholesterol. The norm in men: 29-62 milligrams per deciliter. The norm in women: 34-82 milligrams per deciliter. High level – protection against arterial sclerosis.Physical activity and certain medications can raise the level. Low levels are a risk factor for arterial sclerosis.

Bad cholesterol – LDL , a molecule whose function is to transfer cholesterol to various cells of the body. Excess cholesterol, which is carried by this molecule, settles and accumulates on the walls of blood vessels and thus causes them to harden. Therefore, it is called “bad cholesterol”.

Rate: 60-130 milligrams per deciliter. An increased level indicates an insufficient balance of fats and an increased risk of arterial sclerosis and an increased risk of heart disease.A low level indicates insufficient nutrition or absorption.

3. Functions of blood coagulation

External or internal injury is treated by the body’s clotting mechanism to stop bleeding. The clotting mechanism consists of various cells (mainly platelets, which are formed in the bone marrow) and various proteins, which are formed mainly in the liver. Dysfunction of the liver leads to a violation of the mechanism of coagulation in the body. There are three main studies to test clotting function in the body:

1.Measuring the function of a particular branch in the coagulation mechanism – Protrombin Time (PT).

2. Measurement of the function of a particular branch in the coagulation mechanism – Activated Partial Thromboplastin Time (APTT).

3. International index and standard for determining the results of the coagulation mechanism – International Normalized Ratio (INR).

Prothrombin Time – Protrombin Time .

Measurement of the function of a particular branch in the coagulation mechanism.There are significant differences in the results in different laboratories, therefore a new index was opened to allow comparison, the results of different INR laboratories.

Normal: 11-13.5 seconds. A high level indicates liver disease, a lack of certain clotting factors, or treatment with Coumadin (a drug to prevent blood clotting), a high level of vitamin K deficiency.

Measurement of the function of a particular branch in the coagulation mechanism – Activated Partial Thromboplastin Time ( APTT ) .

Normal: 25-35 seconds. An elevated level indicates liver failure, a lack of certain clotting factors, or certain medical conditions.

Index for measuring coagulation – International Normalized Ratio (INR)

International Index and Standard for Determining the Results of the Clotting Mechanism.

Norm: 0.9-1.2. A high level indicates liver disease, a lack of certain clotting factors, or treatment with Coumadin (a drug to prevent blood clotting), a high level of vitamin K deficiency.For diseases that require the use of Coumadin, the INR level should be high. High levels increase the risk of bleeding. Low levels – increased risk of blood clots.

4. Indicators of liver function

The liver in the body is used to screen out, decompose and remove toxins from the body, and various vital components for the normal functioning of the body are formed in the liver. Liver function tests check the amount of liver enzymes in the blood and thus determine the level of liver activity or damage.

Bilirubin – Bilirubin , one of the breakdown formations of hemoglobin (a protein responsible for the delivery of oxygen to the cells of the body and for the removal of carbon dioxide from the cells into the lungs). Rate: 0.3-1.9 milligrams per deciliter.

In the case of an elevated bilirubin level, two subtypes are tested – direct and indirect.

Direct bilirubin – Direct Bilirubin passed through the liver. High levels of direct bilirubin may indicate a blockage in the bile ducts or a certain liver disorder.

Indirect bilirubin – Indirect Bilirubin , not passed through the liver. High levels of indirect bilirubin may indicate increased breakdown of red blood cells or another blood disorder. It may also indicate liver disease.

Alkaline Phosphatase – (Alk Phos | ALP) , one of the enzymes produced in the liver.

Rate: 44-147 IU per liter. Elevated levels may indicate liver disease, alcoholism, anemia, overactive thyroid, biliary obstruction, and some bone disorders.A low level indicates insufficient nutrition.

Alanine – Alanine Transaminase (ALT-SG P T) , an enzyme involved in the amino acid processing. This enzyme is found primarily in the liver. Used as an index for determining liver damage. Norm: up to 35 international units per liter. An elevated level may indicate liver damage.

Aspartate Transaminase – (AST-SGOT) , an enzyme involved in amino acid processing.The enzyme is found in the liver, in red blood cells, in the heart muscle and other muscles in the body, in the kidneys and in the brain. Used as an index for determining liver damage. Norm: up to 35 international units per liter.

An elevated level may indicate liver damage, increased breakdown of red blood cells, heart disease, or muscle damage. Also, vigorous physical activity can increase the levels of this enzyme, without any clinical significance.

Gamma Glutamyl Transferase (GGT) – is found mainly in the liver and biliary tract, as well as in the kidneys.Norm: up to 51 international units per liter. High levels may indicate excessive alcohol consumption, liver disease, biliary obstruction, or heart failure.

5. Biochemical blood test – SMAC

Provides information about blood constituents that are not cells. Includes proteins, sugars, various salts and fats.

Sugar – Glucose , most abundant in the body. Food carbohydrates break down into glucose. Glucose is carried by the blood to various tissues.Some are consumed by the cells, and some are stored in the muscles and in the liver in the form of glycogen – the storage of the available energy of the body. Fasting rate: 75-110 milligrams per deciliter.

An elevated level indicates the presence of diabetes mellitus. Decreased levels can be caused by an insulin-secreting tumor, lack of nutrition, or high amounts of insulin injected.

Albumin – Albumin , the concentration of protein is mainly in the constituents of the blood. Formed in the liver.It is used as a carrier of many substances in the body (drugs, hormones and salts). Albumin in the blood prevents the release of liquid blood from the blood vessels. Rate: 3.4-5.4 grams per deciliter. A high level indicates a lack of fluid and, as a result, a high concentration of albumin. A low level indicates too much dilution due to fluid buildup, inadequate nutrition, or poor absorption of food.

Sodium – Na , the main electrolyte in the body. Norm: 136-145 miles equivalent per liter.A high level may indicate dehydration, impaired renal function, excessive salt intake, and various endocrinological diseases. A low level may be due to excessive water intake, impaired renal function, various endocrinological disorders.

Potassium – K , the main intracellular electrolyte in the body. Rate: 3.7-5.2 miles equivalent per liter.

High levels can be caused by the breakdown of blood cells in the test tube, muscle breakdown disease, kidney disease, endocrinological disease, various medications, overconsumption.

low levels can be caused by vomiting or intestinal absorption problems, kidney disease, excess urinary excretion, various medications, endocrinological diseases, insufficient food intake.

Chlorine – CL , the main negative ion in the body. The main supply in the body is the salt that we eat.

Rate: 98-106 millimoles per liter.

Calcium – Ca , one of the main constituents of the structure of bones.In the blood, it is in the form of an ion. A very important element in the activity of cells. Rate: 8.5-10.9 milligrams per deciliter. High levels may be associated with thyroid or parathyroid disease, various malignant diseases, kidney failure, overuse of certain diuretics, vitamin D. Low levels may be associated with a lack of parathyroid hormone, vitamin D deficiency, kidney failure, and various eating disorders.

Phosphorus – P , is found in blood and bones. The norm is 1-1.5 millimoles per liter. A high level appears with renal failure and with insufficient function of the parathyroid glands. The low level is mainly with low nutrition, alcoholism, impaired absorption in the intestine, liver failure.

Urea – Urea ( Blood Urea Nitrogen ) , used to determine kidney function.Rate: 7-20 milligrams per deciliter. High level in renal failure, increased protein requirements and various conditions of heart failure, dehydration. Low in liver failure, protein deficiency, or edema.

C -reactive protein – C-reactive Protein (CRP) , a protein that appears in the body during acute inflammation or during various tumor processes. It is not evidence of a process in any particular organ, only indicates the presence of inflammation / tumor.Rate: 0-0.5 milligrams per deciliter.

A high level indicates an inflammatory process or malignancy. High levels are a risk factor for heart disease.

Reaction Sedimentation Erythrocytes – Erythrocyte Sedimentation Rate (ESR) .
Norm: less than 20 millimeters per hour

Test checks the sedimentation rate of blood cells in a test tube over one hour. Increased sedimentation indicates an inflammatory or neoplastic process, which is similar to the study of C – reactive protein.Research does not indicate the origin of the problem. Increased ESR can occur in various conditions, including full health. If an increased ESR is obtained, it can be verified with the study of C-reactive protein.

A level above 50 millimeters per hour indicates an inflammatory or malignant process. The study is highly nonspecific.

90,000 Let’s decipher the blood test correctly! – ABC of health

Each of us at least once in our life had to donate blood for analysis.Therefore, everyone knows how this process takes place. But there are times when we do not know everything about what can and cannot be done before conducting the analysis. A few words about this.

Important rules

So, refrain from performing X-rays and physiological procedures before laboratory tests. The indicators will be affected by excessive mental stress and taking medications the day before, especially intravenously or intramuscularly.If these simple rules are not followed, then the results may be erroneous and lead to an incorrect diagnosis.

So, get a good night’s sleep and come to the laboratory on an empty stomach. Remember to calm down before drawing blood.

Learning to interpret the results

The ABC of blood is not that difficult. But for many, normal performance is a mystery. How can you read them correctly yourself? What should you first pay attention to?

Here and now we will deal with forms, with columns, where some elements with numbers are listed.

Complete blood count

Your blood will be taken from your finger. According to this analysis, it is possible to determine blood diseases, as well as inflammatory processes that occur in the body.

1. The results show letters – RBC . These are erythrocytes, that is, red blood cells. They are also called the main blood cells. Red blood cells perform many functions, the most important of which is to deliver oxygen to every organ and to all tissues, as well as to remove carbon dioxide from the body.The normal value of erythrocytes for women is 3.7-4.7×10 ¹² / l, for men – 4.0-5.5×10 ¹² / l. An increased number of them indicates cardiovascular diseases, such as heart disease, or acute poisoning of the body. Fewer of them indicate anemia. And then doctors immediately pay attention to another indicator.
2. This is hemoglobin – HGB is a complex protein. Its low level, in fact, indicates an iron deficiency – anemia.The norm for women is 120–140 g / l, for men – 130–160 g / l. The concentration of hemoglobin increases with thickening of the blood, which is observed with dehydration, with erythremia (Vakez disease). A decrease in the concentration of hemoglobin is a sign of anemia, fluid retention in the body (overhydration).
3. Hematocrit is designated HCT is the ratio of the volume of blood cells (erythrocytes) to blood plasma. A decrease in hematocrit is observed with blood loss, massive injuries, starvation, blood thinning due to intravenous administration of large volumes of fluid, during pregnancy.Increased hematocrit is noted with dehydration – excessive fluid loss or insufficient fluid intake, with burn disease, peritonitis, kidney pathology. The norm for women is 0.36-0.46 l / l, for men – 0.41-0.53 l / l, for newborns 0.54-0.68 l / l.
4. RDW is the red blood cell distribution width. The indicator determines how red blood cells differ in size. Normally, this is from 11.5 to 14.5%.If the blood consists of both large and small red blood cells, then the width of their distribution will be higher. This condition indicates iron deficiency, and other types of anemia.
5. MCV , that is, the average volume of erythrocytes, distinguishes between different types of anemias in order to choose the correct method of treatment. MCV is a fairly accurate parameter, but if there are a lot of erythrocytes in the blood, and even with a changed shape, then its reliability drops.Normal MCV is 80 to 100 femtoliters (unit of measurement). The MCV indicator determines the type of anemia (microcytic, macrocytic, normocytic).
6. The average hemoglobin content in an erythrocyte or MCH (norm 27 – 35 picograms) shows what is the absolute number of hemoglobin contained in 1 erythrocyte. It really determines the deficiency or not the absorption of iron in the body. According to this indicator, anemia is characterized as hypochromic, normochromic and hyperchromic.The important thing is that the SIT must be correlated with the ICSU and the MCV. But on the basis of a comprehensive consideration, anemias of various types are distinguished.
7. MCSU is the average concentration of hemoglobin in an erythrocyte. It reflects the extent to which the erythrocyte is saturated with hemoglobin. The norm is 310 – 360 g / l. Increased MSCS cannot be, for crystallization will occur. But a reduced value indicates iron deficiency anemia, thalassemia (a disease in which hemoglobin synthesis is disrupted).
8. PLT means platelets – cells responsible for blood clotting. Norm – 150 – 400×10 ⁹ / l. If there are few of them, then there will be increased bleeding, constant bruising. Increased levels can lead to the risk of blood clots – blood clots.
9. Abbreviation WBC stand for leukocytes, that is, white blood cells, the body’s defenders.Their norm is from 4.5 to 9×10 ⁹ / l. An increase in white blood cells is a sign of inflammation in the body, their decrease is a sign of a person’s poor resistance to infections.
10. Lymphocytes are designated LIM . Their percentage is 25–35 of the total number of leukocytes. If an excess is noted, then viral and chronic bacterial infections can be assumed.
11. Content of neutrophils, eosinophils, basophils.These cells are also called the generalized concept – granulocytes. In order to determine the nature of the changes, the ratio of each type in percentage is usually studied. The rate of monocytes is 2-6%, eosinophils 0.5-5%, basophils 0-1%. The number of eosinophils increases with allergies and parasitic diseases (worms), neutrophils – various kinds of inflammation, basophils – chronic myeloid leukemia, chronic ulcerative colitis, some skin lesions.
12. Monocytes ( MON ) are immature cells. Only in tissues do they become macrophages, that is, cells that absorb disease pathogens, dead cells and foreign particles. As a percentage, the norm of MON is from 2 to 6. An increase in monocytes indicates an infectious process, that is, the penetration of microorganisms into the human body, and a decrease indicates a decrease in immunity.
13. ESR is an indicator of the erythrocyte sedimentation rate, which is a non-specific indicator of the state of the body.Its norm for women is 2-15 mm / h, for men – 1-10 mm / h. An increase in the indicator above these values ​​is a sign of inflammation. Also, ESR can increase with various tumors. Its low indicators are extremely rare, they speak of erythrocytosis (many red blood cells). With this disease, the blood becomes viscous and thick and viscous from a large number of red blood cells, which creates the risk of blood clots, vascular blockages and can lead to heart attack and stroke.

So, you already have the knowledge, but it is certainly impossible to prescribe treatment for yourself by adjusting the indicators to the norm.

It should be remembered that our body is a wise system. And in collaboration with an experienced doctor, it will be easier to establish all its functions. And a blood mirror will greatly help in this.

We also offer to use the service – Decoding of analyzes on-line

Author: Ekaterina Solovieva

Please note that the information presented on the site is for informational and educational purposes and is not intended for self-diagnosis and self-medication.The choice and prescription of drugs, treatment methods, as well as control over their use can only be carried out by the attending physician. Be sure to consult with a specialist.

Eye Microsurgery Center “I SEE”

Received: 10.10.2020

I want to express my gratitude to the surgeon, Grigoriev Igor Alexandrovich, for his qualifications and golden hands, professional qualities.
Last month, I underwent 2 operations with Igor Alexandrovich to replace lenses in both eyes due to a high degree of hyperopia.I had not been interested in the subject of eye disease before. But my vision has been deteriorating over the years and with increasing progression. Once in the clinic “I see” and only after a detailed and high-quality consultation of Igor Alexandrovich, I decided to have the operation. Yes, before that I read and even consulted in several clinics and with doctors. The choice stopped here. In my case, it was very important to choose a surgeon and a clinic with the appropriate equipment.
I have not regretted it. Everything was done perfectly, without unnecessary unrealistic promises.That is, as I was told before the operation, what kind of vision will be in the case of choosing such and such lenses, or such and such, this is exactly how it turned out. This speaks of professionalism.
The operations took place without any complications, no pain. Everything is fine! In the postoperative mode, I also received detailed consultations.
Igor Aleksandrovich is a professional in his field, and besides, a friendly doctor (despite the fact that someone left a review that he is a harsh doctor and rude, I absolutely disagree with this.In this work, it is very important to concentrate, and at the right time to explain to the patient how to correct his posture during the operation. And considering many factors, this way of explanation can be different, but professional. This is exactly how Igor Aleksandrovich behaves both during operations and during consultations).
I recommend Grigorieva I.A., if you face the same problems as me or others, where surgery is required!
The clinic itself and the staff deserve thanks too.The clinic is clean. large, comfortable, with all the necessary equipment and certificates.
It is not for nothing that there are a lot of patients treated there.
Thank you, Igor Alexandrovich and the staff of the clinic “I see”

90,000 causes of low, high levels – Health – Home

A blood test for hematocrit shows the percentage of individual blood elements (erythrocytes, leukocytes and platelets) to its liquid part (plasma). With the help of this indicator, the degree of anemia is often determined, since in this disease the hematocrit level can decrease to 15-20%.

It is believed that the average hematocrit for men is between 0.4 and 0.48. And for women, the norm is in the range of 0.36-0.46. However, the hematocrit value directly depends on the person’s age. The younger the patient, the lower the level. In a young child, the hematocrit is typically 20 percent higher than that of an adult. This indicator is considered to be the norm.

Sometimes an increase or decrease in the hematocrit level indicates the presence of a disease.In particular, with prolonged lack of air (hypoxia), the body tries to increase the efficiency of oxygen transfer by blood from the lungs to all organs. This is done by increasing hemoglobin and increasing the number of red blood cells. Accordingly, there is an increase in the level of hematocrit. This effect is present in people with respiratory problems, in tourists who often visit the mountains, in those who live in these areas, as well as in smokers.

The hematocrit can also be elevated when the body is dehydrated (dehydration).What happens with infectious diseases of the digestive system, with severe burns and with a long stay in a dry hot climate. Another reason for an increase in hematocrit is kidney cancer. In this case, an increase in blood density is observed. However, a more accurate diagnosis can be made only after additional examinations.

Those who are in hot climates for a long time tend to get a lot of sun exposure. About whether it is useful or harmful to sunbathe, see the plot from the program “No forbidden topics”:

A decreased hematocrit can also indicate the presence of various diseases.A low test result count is considered an underlying symptom of hypoplastic anemia. Also, the level of hematocrit is low with an excessive presence of fluid in the blood, otherwise called overhydration. The reasons may be: poisoning, infectious or viral disease, renal failure.

Also, a decreased hematocrit may be a sign of hyperproteinemia. This is a decrease in blood density. This can be the case with serious liver disease.

If, according to the results of the analysis, the hematocrit has an increased or decreased level, this only means that additional tests and examinations are needed. There is no point in panic, because often the hematocrit is successfully leveled out with proper nutrition, which includes all the vitamins the body needs, as well as with refusal from alcohol and cigarettes.

Hematology

Preparation for examination:

It is recommended to donate blood in the morning on an empty stomach (at least 8 hours after a meal), in the morning, before taking medications.If withdrawal of the drug is not possible, you must inform the doctor about this. According to the doctor’s prescription, you can donate blood during the day, but not earlier than 2-4 hours after an abundant meal.

It is advisable to exclude physical and emotional stress, smoking 1 hour before the study.

Influence of various factors on the result: the level of leukocytes can increase within 2-4 hours after eating.

Erythrocyte sedimentation rate (ESR)

The erythrocyte sedimentation rate (ESR) is a non-specific indicator of inflammation.ESR depends on the diameter and volume of erythrocytes, their number (increase – slows down, decrease – accelerates), on the content of bile acids and pigments in the plasma, blood viscosity. The ESR is influenced by a change in the ratios of various fractions of blood proteins, the intake of certain medications. ESR is not an indicator specific to any disease, however, an increase in ESR almost always indicates the presence of a pathological process. Indications for appointment: inflammatory processes; infectious diseases; malignant tumors; autoimmune diseases; screening study during preventive examinations.

Preparation for research:

It is recommended to donate blood in the morning on an empty stomach (at least 8 hours after a meal), in the morning, before taking medications.

If withdrawal of the drug is not possible, it is necessary to inform the doctor about this. According to the doctor’s prescription, you can donate blood during the day, but not earlier than 2-4 hours after an abundant meal.

It is advisable to exclude physical and emotional stress, smoking 1 hour before the study.

Influence of various factors on the result:

• during pregnancy, there is an increase in ESR;
• fluctuations during the day: during the day, ESR is usually higher than in the morning;
• in a child, ESR may be slightly increased with a strong cry before the blood collection procedure;
• taking a number of medications can change the result;
• physiotherapy procedures, exposure to X-rays on the eve of the study may slightly affect the result.

Complete blood count – Medical Diagnostic and Treatment Center

GENERAL BLOOD ANALYSIS

Clinical blood test (complete blood count) – analysis included in the mandatory diagnostic minimum. It is performed for all patients admitted to the hospital, as well as for the majority of patients with outpatient treatment. Thanks to a clinical blood test, you can get an idea of ​​the state of the body: the presence of inflammation, anemia.

A general blood test is to determine the number of erythrocytes, hemoglobin levels, the number of leukocytes (both the total and the percentage of various forms of leukocytes), the number of platelets, the level of hematocrit and ESR (ESR).

Blood for clinical analysis must be taken on an empty stomach, and preferably at the same time.

Decoding of the general blood test (clinical blood test).

I. The main indicators of the clinical blood test.

There are a number of indicators of a general blood test, by assessing which you can make a first impression of the patient. Among them are:

1. RBC – Red Blood Cells

This indicator indicates the number of red blood cells contained in the blood.Units of measurement 10 * 12 / liter. Erythrocytes are blood cells containing hemoglobin. The main function of red blood cells is to carry oxygen. A normal red blood cell has a biconcave shape. Thanks to this shape, the surface area of ​​the erythrocyte increases, and the binding of the erythrocyte to oxygen is facilitated. The average life cycle of an erythrocyte is 120 days.

Norms of the number of RBC (norm of red blood cells):

• Men: 4.5-5.5 * 10 ¹² / L
• Women: 4.0-5.0 * 10 ¹² / L

An increase in the number of red blood cells in the blood is called erythrocytosis. Erythrocytosis are absolute and relative. Absolute erythrocytosis occurs when the number of erythrocytes increases. Relative erythrocytosis occurs when the blood thickens (decreases its volume).

Decreased red blood cell count is called erythropenia. Erythropenia occurs, for example, with bleeding.

2. Hb (HGB) – Hemoglobin (hemoglobin)

This indicator characterizes the saturation of the blood with hemoglobin.Hemoglobin is a pigment found in red blood cells. The main function of hemoglobin is to transport oxygen (O ₂ ) and carbon dioxide (CO ₂ ). Hemoglobin plays a critical role in human respiration. Hemoglobin values ​​differ between men and women, in addition, normal hemoglobin levels differ at different ages. In men, the hemoglobin level is slightly higher than in women.

Norms of hemoglobin (HGB norms):

• Men: 120-170 g / L
• Women: 110-155 g / L

A decrease in the level of hemoglobin (anemia) may indicate a person’s bleeding, lack of iron in the body, vitamin B 12.An increase in hemoglobin levels is much less common. May be associated with thickening of the blood (dehydration), erythrocytosis, in athletes, residents of highlands.

3. WBC (Leu) – White blood cells

This indicator indicates the number of white blood cells (leukocytes) in the blood.

• Units WBC – * 10 ⁹ / L

Normal indicators of the level of leukocytes fluctuate depending on the age of the person, and even from the region of his residence.

Average indicators of the norm WBC (leukocyte count): 6-10 * 10 ⁹ / l.

The main function of leukocytes is to participate in the defense mechanisms of the body. An increase in white blood cell count is called leukocytosis. Leukocytosis is accompanied by infectious diseases, leukemias, burns, malignant neoplasms and many other diseases.

A decrease in the level of leukocytes is called leukopenia.

All leukocytes can be divided into 5 groups (leukocyte formula):

a.Neutrophils (norm 45-70%)

• Promyelocytes
• Metamyelocytes
• Stab
• Segment core

Neutrophils are the largest fraction of leukocytes. Their main function is to fight microorganisms (infectious agents). The number of neutrophils increases in acute inflammatory diseases. In this case, a so-called shift of the leukocyte formula to the left can occur.With such a shift, metamyelocytes appear in the blood, and with a sufficiently pronounced inflammatory process, promyelocytes.

b. Lymphocytes (Norm 19-37%)

Lymphocytes respond to the body’s immune response. Among the lymphocytes, T and B lymphocytes are distinguished. The level of lymphocytes rises, for example, with a viral infection. The level of lymphocytes decreases with immunodeficiency.

c. Monocytes (Norm 3-11%)

Monocytes are the largest cells among leukocytes.Monocytes are the precursors of macrophages. The main function of monocytes / macrophages is phagocytosis.

g. Eosinophils (Norm 1-5%)

Eosinophils are involved in allergic reactions in response to parasitic invasion.

f. Basophils (Rate 0-1%)

The main function of basophils is to participate in an immediate hypersensitivity reaction.

4. PLT – Platelets

This indicator indicates the number of platelets in the blood.

• PLT (platelet) measurement units – * 10 ⁹ / L
• Norm of platelet count (norm PLT) – 150-400 * 10 ⁹ / l

The main function of platelets is participation in the blood coagulation system and in the processes of fibrinolysis. The number of platelets can increase, for example, in acute blood loss, after splenectomy, with myeloid leukemia. A decrease in platelet count is called thrombocytopenia. Thrombocytopenia can be congenital (Fanconi syndrome, Wiskot-Aldrich syndrome, etc.) and acquired (medicinal, with splenomegaly, etc.).

5. HCT (Ht) – Hematocrit

This indicator characterizes the ratio of the total volume of all erythrocytes to the volume of plasma.

• Measured in percent (%).
• Norm of hematocrit (HCT) – 35-45%.

The level of hematocrit increases with an increase in the number of red blood cells (erythrocytosis), with an increase in the volume of red blood cells. Hematocrit (HCT) decreases with a decrease in the number of erythrocytes, a decrease in their volume, hemodelution (for example, with intensive infusion therapy with crystalloid solutions).

6. ESR – ESR (erythrocyte sedimentation rate)

This indicator indicates the erythrocyte sedimentation rate.