What does high hemoglobin and hematocrit mean? How are these values measured? Get the answers to these questions and more in this informative guide.

Understanding Hemoglobin and Hematocrit

Hemoglobin (Hb) is a protein found in red blood cells that is responsible for delivering oxygen to the body’s tissues. The amount of hemoglobin present in the blood is measured in grams per deciliter (g/dL). Normal hemoglobin levels are typically 14-18 g/dL for men and 12-16 g/dL for women.

Hematocrit (Hct) is a measure of the volume of red blood cells compared to the total volume of blood. It is typically expressed as a percentage, with normal ranges of 40-54% for men and 36-48% for women.

Causes of High Hemoglobin and Hematocrit

High hemoglobin and hematocrit levels, known as erythrocytosis, can have several causes, including:

• Dehydration: When a person is dehydrated, the concentration of red blood cells and hemoglobin increases, leading to higher Hb and Hct values.
• Polycythemia vera: A rare disorder in which the body produces too many red blood cells, leading to elevated Hb and Hct.
• High altitude: Living or spending time at high altitudes can cause the body to produce more red blood cells to compensate for the lower oxygen levels.
• Certain medications: Some medications, such as anabolic steroids, can stimulate red blood cell production and increase Hb and Hct.
• Lung or heart disease: Conditions that affect the lungs or heart can lead to compensatory increases in red blood cell production.

Measuring Hemoglobin and Hematocrit

Hemoglobin and hematocrit are typically measured using a blood sample. For hematocrit, a small blood sample is collected, usually from a finger prick or venipuncture, and placed in a heparinized microhematocrit tube. The tube is then centrifuged, and the ratio of packed red blood cells to the total volume of blood is calculated.

Hemoglobin is usually measured using an automated cell counter, where the blood sample is mixed with a reagent that converts all forms of hemoglobin to a colored compound that can be measured by a colorimeter.

Interpreting High Hemoglobin and Hematocrit

When hemoglobin and hematocrit levels are elevated, it is essential to determine the underlying cause. High values may indicate dehydration, a chronic lung or heart condition, or a rare disorder like polycythemia vera. In some cases, high levels may be normal, such as for individuals living at high altitudes.

If the high Hb and Hct are due to an underlying condition, treatment may involve addressing the root cause, such as managing a chronic disease or adjusting medication. In cases of polycythemia vera, phlebotomy (blood removal) may be necessary to reduce the red blood cell count.

Potential Complications of High Hemoglobin and Hematocrit

Elevated Hb and Hct levels can lead to several potential complications, including:

• Increased blood viscosity, leading to a higher risk of blood clots
• Headaches, dizziness, and fatigue due to the increased red blood cell count
• An increased risk of heart attack and stroke due to the increased workload on the cardiovascular system

Monitoring and Management

Regular monitoring of hemoglobin and hematocrit levels is essential for individuals with high values. This may involve periodic blood tests and close collaboration with a healthcare provider to identify and address the underlying cause.

Treatment options may include lifestyle changes, such as staying hydrated, as well as medication or other medical interventions, depending on the specific cause of the elevated Hb and Hct.

Key Takeaways

• Hemoglobin and hematocrit are measurements of red blood cell and oxygen-carrying capacity in the blood.
• High hemoglobin and hematocrit, known as erythrocytosis, can have various causes, including dehydration, lung/heart disease, and certain medical conditions.
• Proper measurement and interpretation of Hb and Hct levels are crucial for identifying the underlying cause and determining appropriate treatment.
• Monitoring and managing high Hb and Hct is important to prevent potential complications, such as increased risk of blood clots and cardiovascular events.

Hemoglobin and Hematocrit – Clinical Methods

Definition

Hemoglobin (Hb) is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained. The amount of hemoglobin in whole blood is expressed in grams per deciliter (g/dl). The normal Hb level for males is 14 to 18 g/dl; that for females is 12 to 16 g/dl. When the hemoglobin level is low, the patient has anemia. An erythrocytosis is the consequence of too many red cells; this results in hemoglobin levels above normal.

The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. Automated cell counters calculate the hematocrit by multiplying the red cell number (in millions/mm³) by the mean cell volume (MCV, in femtoliters). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152).

Both the hemoglobin and the hematocrit are based on whole blood and are therefore dependent on plasma volume. If a patient is severely dehydrated, the hemoglobin and hematocrit will appear higher than if the patient were normovolemic; if the patient is fluid overloaded, they will be lower than their actual level. To assess true red cell mass, independent radionuclide evaluation of the red cells and plasma (by ⁵¹Cr and ¹³¹I respectively) must be performed.

Technique

Hematocrit

If the hematocrit must be determined quickly, as is often the case when a patient hemorrhages, it may be necessary to measure the hematocrit directly without the use of an automated counter. The materials needed are:

• Lancets

• Alcohol prep pads

• Gauze pads

• Microhematocrit tubes (heparinized)

• Sealant (“Seal-Ease,” “Crit-Seal,” etc)

• Microhematocrit centrifuge

• Microhematocrit reader

• If venipuncture is required: tourniquet, syringe, tube containing anticoagulant (EDTA, citrate)

For hematocrits obtained by fingerstick, wipe the fingertip pad of the fourth finger of the nondominant hand with the alcohol prep pad. Make certain the area is allowed to dry. Prick the fingertip with the lancet. Place the hematocrit tube near the incision site and allow the blood to flow via capillary action into the hematocrit tube until it is two-thirds to three-fourths full or to a predesignated mark on the tube. Avoid “milking” the finger if possible; this causes the expression of tissue fluids and may result in a falsely low hematocrit. Always fill at least three tubes. For hematocrits obtained by venipuncture, draw a sample of blood into the tube containing anticoagulant and mix well. Dip the hematocrit tube into the blood and allow the blood to rise to the desired two-thirds to three-quarters level. Because blood cells naturally sediment, a prior thorough mixing of the blood in the tube is necessary to ensure accurate reading.

After cleaning the outside of the hematocrit tubes of excess blood, invert the tube slowly so that the blood migrates just short of the bottom end of the tube. Seal the bottom of the tube with sealant. Make certain that little or no air is interspersed in the column of blood. If the seal is incomplete, leakage will occur during centrifugation and false readings will be obtained.

Place the tubes in a microhematocrit centrifuge and spin for 3 to 5 minutes at high speed. A shorter spin will not allow for complete sedimentation.

Using either a hematocrit reader or any ruled apparatus, measure the length of the column of the packed red cells and divide it by the length of the whole column of blood (cells and plasma), as in . To obtain the hematocrit, multiply this number by 100%. Average all readings obtained from the different microhematocrit tubes.

Figure 151.1

Microhematocrit tube after sedimentation. The hematocrit is a ratio of the packed cells to total volume.

Example: If the column of packed red cells measures 20 mm and the whole blood column measures 50 mm, the hematocrit is 20/50 = 0.4 or (0.4 × 100%) = 40%.

Hemoglobin

Hemoglobin determinations will usually be performed by an automated cell counter from a tube of well-mixed EDTA-anticoagulated blood filled to a predetermined level. In this assay, all forms of hemoglobins are converted to the colored protein cyanomethemoglobin and measured by a colorimeter. An inadequate sample, whether due to insufficient volume or inadequate anticoagulation, may give false readings. If it is necessary to determine the level of anemia quickly, the hematocrit is an easier, more convenient test.

Hemoglobin Electrophoresis

Hemoglobin electrophoresis measures the mobility of hemoglobin in an electric field; it can therefore detect only those abnormalities in hemoglobin that alter the charge. Electrophoretic mobilities are affected by pH and by the medium in which the test is conducted. Screening tests typically use a hemolysate of anticoagulated blood electrophoresed on cellulose acetate at pH 8.6 to 8.8. If necessary, a further electrophoresis in starch gel at pH 6.2 to 6.8 is performed. At that stage, the work will usually be performed by a specialized laboratory.

Hemoglobin electrophoresis will not readily assess situations where there are neutral amino acid substitutions or where the hemoglobin is normal but the constituent chains are not produced in equal numbers (thalassemias). The diagnosis of alpha thalassemia of a mild to moderate degree cannot be made by hemoglobin electrophoresis; the diagnosis of beta thalassemia may be made by inference from an increase in the Hb A₂.

A standard electrophoresis would look like .

Figure 151.2

A standard hemoglobin electrophoresis (cellulose acetate, pH 8.6).

Basic Science

The molecular weight of hemoglobin is approximately 64,500 daltons. Hb is composed of two pairs of dissimilar chains, α and β, each defined by a specific amino acid sequence and incorporating an iron-containing heme group. Two α–β dimers combine to form a hemoglobin tetramer. This allows for the “heme–heme” interaction necessary for effective oxygen uptake (deoxyhemoglobin → oxyhemoglobin) and delivery (oxyhemoglobin → deoxyhemoglobin). The oxygen affinity of hemoglobin is a function of this heme–heme interaction and of pH (Bohr effect), and is a measure of how many hemoglobin molecules have oxygen bound to them for a given level of oxygen tension. In a normal individual the major hemoglobin is Hb A, constituting approximately 97% of the total hemoglobin. Variations and/or amino acid substitutions in these chains exist. Some are deleterious to the normal function of hemoglobin, whereas others may have relatively normal oxygen affinity and stability. Hemoglobins containing different types of chains make up the remainder of the hemoglobin content in red cells (α₂δ₂ = Hb A₂ approximately 2%; α₂γ₂ = Hb F approximately 1%).

Substitutions in the normal hemoglobin amino acid sequence may result in hemoglobins that have different sub-unit interactions and varying affinities for oxygen. For example, a substitution of the sixth amino acid on the beta chain causes Hb S, or sickle hemoglobin. Hb S has a lower oxygen affinity and surrenders its oxygen more readily. Hb F, a normal minor hemoglobin constituent, has a higher oxygen affinity.

If the oxygen dissociation curve is abnormal, the body will adjust the hemoglobin level to ensure adequate oxygen distribution to the tissues. Thus in a rare disease like hemoglobin Hotel Dieu, the difficulty in extracting oxygen from a variant hemoglobin with increased oxygen affinity could result in a lack of oxygen for the tissues (tissue hypoxia) and a compensatory erythrocytosis. The smaller fraction of oxygen released from the hemoglobin is thereby offset by the increased number of hemoglobin molecules. Similarly, in sickle cell anemia, the decreased oxygen affinity allows these patients more tissue oxygen at any given hemoglobin level.

Clinical Significance

Many anemias are detected by routine laboratory screening performed before the patient is symptomatic. When the patient does have symptoms from an abnormality in the hemoglobin level, the symptoms are often a nonspecific weakness or fatigue. The only finding on physical examination may be pallor; additional changes in the nail beds (such as spooning), glossitis (red tongue), or hepatosplenomegaly (enlarged liver or spleen) may give a clue to the etiology of the anemia. Symptoms are usually related to the level of hemoglobin, its abruptness of onset and its duration. A patient with pernicious anemia may feel well at the same level of hemoglobin that would cause severe weakness in a patient with acute gastrointestinal hemorrhage. This is due to volume compensation by plasma and shifts in the oxygen dissociation curve which occur over time.

When first confronted with an abnormal hemoglobin or hematocrit level, the next step is to assess the red cell indices (see Chapter 152), peripheral smear (Chapter 155), and the reticulocyte count (Chapter 156) in light of the patient’s history and physical examination.

References

1. Adamson JW, Finch CA. Hemoglobin function, oxygen affinity and erythropoietin. Annu Rev Physiol. 1975;37:351. [PubMed: 235878]

2. Bunn HF. Hemoglobin I. Structure and function. In: Beck WS, Hematology. Cambridge, MA: MIT Press, 1981;129.

3. Scott AF. et al. The molecular basis of hemoglobin. Am J Hum Genet. 1981;33:129. [PMC free article: PMC1684884] [PubMed: 6258429]

4. Wallerstein RO. Laboratory evaluation of anemia. West J Med. 1987;146:443. [PMC free article: PMC1307333] [PubMed: 3577135]

Hemoglobin and Hematocrit – Clinical Methods

Definition

Hemoglobin (Hb) is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained. The amount of hemoglobin in whole blood is expressed in grams per deciliter (g/dl). The normal Hb level for males is 14 to 18 g/dl; that for females is 12 to 16 g/dl. When the hemoglobin level is low, the patient has anemia. An erythrocytosis is the consequence of too many red cells; this results in hemoglobin levels above normal.

The hematocrit measures the volume of red blood cells compared to the total blood volume (red blood cells and plasma). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. Automated cell counters calculate the hematocrit by multiplying the red cell number (in millions/mm³) by the mean cell volume (MCV, in femtoliters). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152).

Both the hemoglobin and the hematocrit are based on whole blood and are therefore dependent on plasma volume. If a patient is severely dehydrated, the hemoglobin and hematocrit will appear higher than if the patient were normovolemic; if the patient is fluid overloaded, they will be lower than their actual level. To assess true red cell mass, independent radionuclide evaluation of the red cells and plasma (by ⁵¹Cr and ¹³¹I respectively) must be performed.

Technique

Hematocrit

If the hematocrit must be determined quickly, as is often the case when a patient hemorrhages, it may be necessary to measure the hematocrit directly without the use of an automated counter. The materials needed are:

• Lancets

• Alcohol prep pads

• Gauze pads

• Microhematocrit tubes (heparinized)

• Sealant (“Seal-Ease,” “Crit-Seal,” etc)

• Microhematocrit centrifuge

• Microhematocrit reader

• If venipuncture is required: tourniquet, syringe, tube containing anticoagulant (EDTA, citrate)

For hematocrits obtained by fingerstick, wipe the fingertip pad of the fourth finger of the nondominant hand with the alcohol prep pad. Make certain the area is allowed to dry. Prick the fingertip with the lancet. Place the hematocrit tube near the incision site and allow the blood to flow via capillary action into the hematocrit tube until it is two-thirds to three-fourths full or to a predesignated mark on the tube. Avoid “milking” the finger if possible; this causes the expression of tissue fluids and may result in a falsely low hematocrit. Always fill at least three tubes. For hematocrits obtained by venipuncture, draw a sample of blood into the tube containing anticoagulant and mix well. Dip the hematocrit tube into the blood and allow the blood to rise to the desired two-thirds to three-quarters level. Because blood cells naturally sediment, a prior thorough mixing of the blood in the tube is necessary to ensure accurate reading.

After cleaning the outside of the hematocrit tubes of excess blood, invert the tube slowly so that the blood migrates just short of the bottom end of the tube. Seal the bottom of the tube with sealant. Make certain that little or no air is interspersed in the column of blood. If the seal is incomplete, leakage will occur during centrifugation and false readings will be obtained.

Place the tubes in a microhematocrit centrifuge and spin for 3 to 5 minutes at high speed. A shorter spin will not allow for complete sedimentation.

Using either a hematocrit reader or any ruled apparatus, measure the length of the column of the packed red cells and divide it by the length of the whole column of blood (cells and plasma), as in . To obtain the hematocrit, multiply this number by 100%. Average all readings obtained from the different microhematocrit tubes.

Figure 151.1

Microhematocrit tube after sedimentation. The hematocrit is a ratio of the packed cells to total volume.

Example: If the column of packed red cells measures 20 mm and the whole blood column measures 50 mm, the hematocrit is 20/50 = 0.4 or (0.4 × 100%) = 40%.

Hemoglobin

Hemoglobin determinations will usually be performed by an automated cell counter from a tube of well-mixed EDTA-anticoagulated blood filled to a predetermined level. In this assay, all forms of hemoglobins are converted to the colored protein cyanomethemoglobin and measured by a colorimeter. An inadequate sample, whether due to insufficient volume or inadequate anticoagulation, may give false readings. If it is necessary to determine the level of anemia quickly, the hematocrit is an easier, more convenient test.

Hemoglobin Electrophoresis

Hemoglobin electrophoresis measures the mobility of hemoglobin in an electric field; it can therefore detect only those abnormalities in hemoglobin that alter the charge. Electrophoretic mobilities are affected by pH and by the medium in which the test is conducted. Screening tests typically use a hemolysate of anticoagulated blood electrophoresed on cellulose acetate at pH 8.6 to 8.8. If necessary, a further electrophoresis in starch gel at pH 6.2 to 6.8 is performed. At that stage, the work will usually be performed by a specialized laboratory.

Hemoglobin electrophoresis will not readily assess situations where there are neutral amino acid substitutions or where the hemoglobin is normal but the constituent chains are not produced in equal numbers (thalassemias). The diagnosis of alpha thalassemia of a mild to moderate degree cannot be made by hemoglobin electrophoresis; the diagnosis of beta thalassemia may be made by inference from an increase in the Hb A₂.

A standard electrophoresis would look like .

Figure 151.2

A standard hemoglobin electrophoresis (cellulose acetate, pH 8.6).

Basic Science

The molecular weight of hemoglobin is approximately 64,500 daltons. Hb is composed of two pairs of dissimilar chains, α and β, each defined by a specific amino acid sequence and incorporating an iron-containing heme group. Two α–β dimers combine to form a hemoglobin tetramer. This allows for the “heme–heme” interaction necessary for effective oxygen uptake (deoxyhemoglobin → oxyhemoglobin) and delivery (oxyhemoglobin → deoxyhemoglobin). The oxygen affinity of hemoglobin is a function of this heme–heme interaction and of pH (Bohr effect), and is a measure of how many hemoglobin molecules have oxygen bound to them for a given level of oxygen tension. In a normal individual the major hemoglobin is Hb A, constituting approximately 97% of the total hemoglobin. Variations and/or amino acid substitutions in these chains exist. Some are deleterious to the normal function of hemoglobin, whereas others may have relatively normal oxygen affinity and stability. Hemoglobins containing different types of chains make up the remainder of the hemoglobin content in red cells (α₂δ₂ = Hb A₂ approximately 2%; α₂γ₂ = Hb F approximately 1%).

Substitutions in the normal hemoglobin amino acid sequence may result in hemoglobins that have different sub-unit interactions and varying affinities for oxygen. For example, a substitution of the sixth amino acid on the beta chain causes Hb S, or sickle hemoglobin. Hb S has a lower oxygen affinity and surrenders its oxygen more readily. Hb F, a normal minor hemoglobin constituent, has a higher oxygen affinity.

If the oxygen dissociation curve is abnormal, the body will adjust the hemoglobin level to ensure adequate oxygen distribution to the tissues. Thus in a rare disease like hemoglobin Hotel Dieu, the difficulty in extracting oxygen from a variant hemoglobin with increased oxygen affinity could result in a lack of oxygen for the tissues (tissue hypoxia) and a compensatory erythrocytosis. The smaller fraction of oxygen released from the hemoglobin is thereby offset by the increased number of hemoglobin molecules. Similarly, in sickle cell anemia, the decreased oxygen affinity allows these patients more tissue oxygen at any given hemoglobin level.

Clinical Significance

Many anemias are detected by routine laboratory screening performed before the patient is symptomatic. When the patient does have symptoms from an abnormality in the hemoglobin level, the symptoms are often a nonspecific weakness or fatigue. The only finding on physical examination may be pallor; additional changes in the nail beds (such as spooning), glossitis (red tongue), or hepatosplenomegaly (enlarged liver or spleen) may give a clue to the etiology of the anemia. Symptoms are usually related to the level of hemoglobin, its abruptness of onset and its duration. A patient with pernicious anemia may feel well at the same level of hemoglobin that would cause severe weakness in a patient with acute gastrointestinal hemorrhage. This is due to volume compensation by plasma and shifts in the oxygen dissociation curve which occur over time.

When first confronted with an abnormal hemoglobin or hematocrit level, the next step is to assess the red cell indices (see Chapter 152), peripheral smear (Chapter 155), and the reticulocyte count (Chapter 156) in light of the patient’s history and physical examination.

References

1. Adamson JW, Finch CA. Hemoglobin function, oxygen affinity and erythropoietin. Annu Rev Physiol. 1975;37:351. [PubMed: 235878]

2. Bunn HF. Hemoglobin I. Structure and function. In: Beck WS, Hematology. Cambridge, MA: MIT Press, 1981;129.

3. Scott AF. et al. The molecular basis of hemoglobin. Am J Hum Genet. 1981;33:129. [PMC free article: PMC1684884] [PubMed: 6258429]

4. Wallerstein RO. Laboratory evaluation of anemia. West J Med. 1987;146:443. [PMC free article: PMC1307333] [PubMed: 3577135]

General (clinical) blood test (CBC)

– is one of the most common examination methods. To conduct a general blood test in our laboratory, blood is taken from a vein. It is recommended to donate blood for this examination in the morning, on an empty stomach (or 4 hours after a meal).

CBC interpretation by the attending physician

CBC interpretation is carried out in several stages, during which the main blood parameters are evaluated. Our laboratory is equipped with modern hematological analyzers made in France, Germany, USA, Japan.

This equipment performs automatic determination of blood parameters and provides the results of the analysis in the form of a printout, in which the main parameters of the blood are indicated by abbreviations in English.

The table below shows the main parameters of the complete blood count and their corresponding English abbreviations.

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What does it mean if the hematocrit is elevated in an adult

What to do if the hematocrit is elevated as a result of a blood test, what does it mean in an adult? Measurement of hematocrit is a simple way to assess the content of red blood cells in the blood.

As a rule, the study is carried out in combination with the determination of the level of hemoglobin, erythrocyte sedimentation rate and platelet count. In this case, the diagnostic value of the indicator increases significantly. One indicator of hematocrit is not enough to determine the state of human health.

What does hematocrit show?

Hematocrit readings accurately reflect the amount of blood that is contained in red blood cells (erythrocytes). In addition, the indicator reflects the size of erythrocyte cells. The standard unit of measure is %.

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Normal values ​​for women from 18 to 45 years old range from 35 to 45%, for men of the same age – from 40 to 50%. With age, the value of the considered indicator begins to increase. So, for women over 60 years old, the allowable rate is in the range from 37 to 49, for men – from 40 to 55%.

A hematocrit value of 35% means that 35 ml of red blood cells are present in 100 ml of the test blood.

The examination is ordered by a general practitioner, pediatrician, surgeon, hematologist, gynecologist or endocrinologist. The analysis is carried out as part of a routine examination or if the development of diseases is suspected, as well as, if necessary, preparation for surgery. Repeated measures of the indicator are necessary to dynamically monitor the effectiveness of the selected treatments. The indicator is also relevant when assessing the patient’s condition after prolonged dehydration.

Hematocrit is elevated, what does this mean in an adult?

An increase in hematocrit in the blood is referred to as erythrocytosis. Relative erythrocytosis is said to be when the patient has a normal number of red blood cells against the background of a decrease in the volume of blood plasma. Let’s take a closer look at each of the conditions and their causes.

Relative erythrocytosis

Main causes:

• prolonged dehydration leading to a decrease in blood plasma volumes;
• burns;
• taking diuretic drugs that promote excessive release of fluid from the human body;
• increased permeability of capillary walls;
• hypertension;
• Geisbeck’s syndrome, which combines a decrease in plasma volumes with hypertension;
• adaptation to conditions of low oxygen content in the air. For example, when climbing high mountains.

Primary erythrocytosis

The increase in hematocrit in this case is due to defects associated with red blood cells. It develops against the background of Wakez’s disease (true polycythemia) – this is a benign pathology of the circulatory system. The patient has a significant increase in the number of erythrocytes and a slight increase in platelets and leukocytes. There is an increase in the viscosity and density of the blood. In the future, a person’s normal blood flow slows down. The formation of blood clots contributing to hypoxia is not excluded.

Pathology affects mainly the elderly, it is less common in young people and children. According to statistics: the average age of patients is 75 years. In young people, the disease is much more severe. The prevalence of the disease does not exceed 29 detected cases per 100 thousand people.

The peculiarity of Wakez’s disease is a long course without clinical manifestations. Hereditary predisposition has been noted.

Complications occur against the background of thrombosis of blood vessels. What prevents the normal blood supply to the brain, limbs and liver. Patients have frequent bleeding and ulcers of the gastrointestinal tract. Due to the increased content of uric acid, stones form in the urinary organs.

The treatment of Wakez disease is reduced to blood thinning and the fight against thrombosis. For help, you should contact a hematologist. Patients are prescribed bloodletting and chemotherapy, which help to reduce the number of red blood cells in the plasma. If necessary, symptomatic treatment is selected.

Patient’s life expectancy exceeds 10 years. Possible adverse outcomes: the development of liver cirrhosis, myelofibrosis or chronic myeloblastic leukemia.

Primary erythrocytosis is also characteristic of a rare genetic pathology – shortening of erythropoietin receptors. Erythropoietin is a hormone synthesized by the kidneys and is responsible for stimulating the formation of red blood cells. Pathology is characterized by increased sensitivity of red blood cells to the hormone, even at its minimum concentrations.

Secondary erythrocytosis

The secondary form of elevated hematocrit (erythrocytosis) is detected when cells are exposed to various stimulants, such as erythropoietin. One of the most powerful incentives for excessive synthesis of the hormone erythropoietin is chronic hypoxia. It is noted in people with pathologies of the lungs and brain, when blood is discharged in the opposite direction (from right to left), as well as against the background of a long stay in the highlands.

Smokers have a similar condition. Since the carbon monoxide contained in cigarette smoke significantly increases the affinity of hemoglobin for oxygen. This prevents its free separation from heme and leads to hypoxia.

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Increased blood hematocrit observed in people with hereditary pathologies:

• hemoglobinopathies with increased affinity for molecular oxygen;
• excessive synthesis of erythropoietin;
• lack of 2,3-diphosphoglycerate.

It should be noted that above normal hematocrit is recorded in people taking steroid male hormones.

In 60% of patients with kidney pathologies, secondary erythrocytosis is noted, which is not compensated by the body’s own forces. Half of the cases are oncological diseases, the rest are cysts and hydronephrosis.

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10% of kidney transplant recipients have secondary erythrocytosis. Cause: rejection of transplanted tissues, narrowing of the lumen of the renal arteries, hydronephrosis, hypertension and excessive secretion of erythropoietin by a healthy kidney. Patients are shown taking diuretic drugs, which also causes increased hematocrit in the blood.

According to the literature data, up to 20% of cases of erythrocytosis are due to a tumor of the vessels of the cerebellum of the brain and hepatocellular carcinoma.

Other causes

Rare causes of elevated hematocrit in adults include:

• fibromyoma is a benign neoplasm that forms in the tissues of the uterus in women. It is more common in premenopausal women. The treatment regimen for the patient is selected based on the size of the neoplasms and their number. There is a wait-and-see strategy that is used in the early stages of the disease. However, the scientific effectiveness of such a solution remains in question. Therefore, even small nodules should be treated immediately;
• ovarian carcinoma is a malignant oncopathology that is found annually in 225,000 women. Despite the great progress in modern medicine and the developed diagnostic techniques, more than 70% of cases are detected already at a late stage. In treatment, preference is given to surgical removal of the affected tissues and chemotherapy. In the first stages, it is enough to remove one ovary. At later stages – the woman’s ovary, uterus and omentum are removed;
• Conn’s syndrome.

Diagnosis

When an elevated hematocrit is detected, it is necessary to conduct a comprehensive examination of the patient, including: It is necessary to exclude the state of chronic dehydration of the patient;

a repeated extended clinical blood test is performed. Particular attention is paid to the level of red blood cells, eosinophils, neutrophils and platelets. Their combined increase indicates erythrocytosis;

Differentiation of relative erythrocytosis from absolute is carried out using 51Cr. This is a highly sensitive technique using labeled antibodies. The intensity of radiation is directly proportional to the number of antigen-antibody complexes formed.

In order to exclude hypovolemia (decrease in blood plasma volume), a technique using labeled albumin protein is implemented.

Advanced diagnostics involves the use of ultrasound and computed tomography of the abdominal organs.

Conclusions

In summary, important points should be emphasized:

• hematocrit value reflects the total volume and size of red blood cells;
• to determine the value under consideration, a special glass transparent tube is used. It is filled with the studied biomaterial, after which it is centrifuged. Then the part of the tubule is marked, which is filled with red blood cells. However, modern laboratory departments are equipped with automatic analyzers. That allows you to get the most accurate indicators with a minimum error;
• hematocrit is not determined in isolation from other indicators of the general blood test. It is necessary to take into account the level of erythrocytes, neutrophils and leukocytes. Only in this case, the diagnostic significance of the indicator increases;
• study is relevant as part of a routine examination of the patient and in the primary diagnosis of various diseases;
• An increase in the indicator can be caused by a number of different reasons.