Reasons for low hgb and hct: Low hemoglobin count | NCH Healthcare System

05.08.202108.06.2023 by alexxlab

Low hemoglobin count | NCH Healthcare System

Definition

A low hemoglobin count is a commonly seen blood test result. Hemoglobin (Hb or Hgb) is a protein in red blood cells that carries oxygen throughout the body.

A low hemoglobin count is generally defined as less than 13.2 grams of hemoglobin per deciliter (132 grams per liter) of blood for men and less than 11.6 grams per deciliter (116 grams per liter) for women. In children, the definition varies with age and sex. These thresholds may differ slightly from one medical practice to another.

In many cases, a low hemoglobin count that’s only slightly lower than normal doesn’t affect how you feel. A low hemoglobin count that’s more severe and causes symptoms might mean you have anemia.

Causes

Normally low hemoglobin counts

A slightly low hemoglobin count isn’t always a sign of illness — it can be normal for some people. Women with menstrual periods and pregnant women commonly have low hemoglobin counts.

Low hemoglobin counts associated with diseases and conditions

A low hemoglobin count can be associated with a disease or condition that causes your body to have too few red blood cells. This can occur if:

Your body produces fewer red blood cells than usual
Your body destroys red blood cells faster than they can be produced
You have blood loss

Diseases and conditions that cause your body to produce fewer red blood cells than normal include:

Aplastic anemia
Cancer
Certain medications, such as antiretroviral drugs for HIV infection and chemotherapy drugs for cancer and other conditions
Chronic kidney disease
Cirrhosis
Hodgkin’s lymphoma (Hodgkin’s disease)
Hypothyroidism (underactive thyroid)
Inflammatory bowel disease (IBD)
Iron deficiency anemia
Lead poisoning
Leukemia
Multiple myeloma
Myelodysplastic syndromes
Non-Hodgkin’s lymphoma
Rheumatoid arthritis
Vitamin deficiency anemia

Diseases and conditions that cause your body to destroy red blood cells faster than they can be made include:

Enlarged spleen (splenomegaly)
Hemolysis
Porphyria
Sickle cell anemia
Thalassemia

A low hemoglobin count can also be due to blood loss, which can occur because of:

Bleeding in your digestive tract, such as from ulcers, cancers or hemorrhoids
Frequent blood donation
Menorrhagia (heavy menstrual bleeding) (heavy menstrual bleeding-although even normal menstrual bleeding may cause a slightly low hemoglobin count)

When to see a doctor

Some people learn that their hemoglobin is low when they try to donate blood. Being turned down for blood donation isn’t necessarily a cause for concern. You can have a hemoglobin count that’s fine for you but doesn’t meet the standards blood donation centers set.

If your hemoglobin count is only a little under the required level, particularly if you’ve been accepted for blood donation in the past, you might just need to wait a couple of months and try again. If the problem continues, make an appointment with your doctor.

Make an appointment if you have signs and symptoms

If you have signs and symptoms of a low hemoglobin count, make an appointment with your doctor. Signs and symptoms can include:

Fatigue
Weakness
Pale skin and gums
Shortness of breath
A fast or irregular heartbeat

Your doctor might recommend a complete blood count test to determine whether you have a low hemoglobin count. If your test reveals that you have a low hemoglobin count, you’ll likely need more testing to determine the cause.

More from the Mayo Library

Update Date: 05-24-2022

Imbalances, symptoms, and risk factors

Hemoglobin is an iron-rich protein in red blood cells. It enables the blood to carry oxygen to tissues throughout the body. Low hemoglobin levels often indicate anemia, but high levels can also be a sign of a serious health condition.

When someone has insufficient red blood cells or the ones they have do not work properly, the body does not have enough of the oxygen it needs to function. This condition is anemia.

Read on to learn more about how hemoglobin levels can affect people, including symptoms, treatment, and outlook for someone with low hemoglobin in their body.

Share on PinterestHemoglobin is a protein in red blood cells that carries oxygen throughout the body.

Each hemoglobin protein contains four iron atoms and can therefore carry four molecules of oxygen. Hemoglobin attaches to red blood cells and delivers oxygen throughout the body — everywhere that blood flows. Every one of the body’s billions of cells needs oxygen to repair and maintain itself.

Hemoglobin also plays a role in helping red blood cells obtain their disc-like shape, which helps them move easily through blood vessels.

How are hemoglobin levels tested?

A blood test can assess hemoglobin levels. This is called a hemoglobin test. Doctors may take a blood sample from the person and send it to a laboratory for testing.

Doctors may measure hemoglobin levels as part of a complete blood count (CBC) test.

A low level of hemoglobin in the blood means there is also a low level of oxygen. This can result in a condition called anemia. Tests usually express hemoglobin, or Hb, in grams per deciliter (g/dL) of blood.

In the United States, doctors diagnose anemia when the test finds hemoglobin levels to be less than 13.5 g/dL in males and less than 12. 0 g/dL in females. The results for children can vary with age.

Learn more about the CBC test here.

High hemoglobin levels could signal a rare blood disorder called polycythemia. In polycythemia, the body makes too many red blood cells, causing the blood to be thicker than usual. This can lead to clots, heart attacks, and stroke. It is a serious lifelong condition that can be fatal without treatment.

Dehydration, smoking, or living at high altitudes may also cause high hemoglobin. It may also signal other conditions, such as lung or heart disease.

Low hemoglobin levels usually indicate that a person has anemia. There are several kinds of anemia:

Iron-deficiency anemia: This is the most common type that can occur when a person does not have enough iron in their body, and it cannot make the hemoglobin the body needs. Blood loss usually causes it, but it can also happen when the body does not absorb enough iron. This can happen, for example, when someone has had gastric bypass surgery.
Pregnancy-related anemia: This is a kind of iron deficiency anemia, which occurs because pregnancy and childbirth require a significant amount of iron.
Vitamin-deficiency anemia: This happens when there are low levels of nutrients, such as vitamin B12 or folic acid — also called folate — in a person’s diet. These anemias change the shape of the red blood cells, which makes them less effective.
Aplastic anemia: This is a disorder where the immune system attacks blood-forming stem cells in the bone marrow, resulting in fewer red blood cells.
Hemolytic anemia: This can be the result of another condition, or it can have a genetic cause. It occurs when the red blood cells break up in the bloodstream or the spleen.
Sickle cell anemia: This is a genetic condition where the hemoglobin protein is abnormal. It means the red blood cells are sickle-shaped and rigid, which stops them from flowing through small blood vessels.

Other conditions, such as kidney disease and chemotherapy for cancer, can cause anemia when they affect the body’s ability to make red blood cells.

Low hemoglobin in infants

Newborns can have temporary anemia when they are 6–8 weeks old. This occurs when they run out of the red blood cells they are born with, but their bodies have not made new red blood cells. This condition will not affect the baby adversely unless they are ill for some other reason.

Babies can also have anemia from breaking down cells too quickly, which results in yellowing skin, a condition known as jaundice. This often occurs if the mother and baby have incompatible blood types.

Learn more about infant jaundice here.

The results of a hemoglobin test will indicate if a person’s hemoglobin levels are within the normal reference range.

Different labs have slightly different guidelines, but in general, normal hemoglobin levels are as follows:

13.5 to 18.0 g/dL in males
12. 0 to 15.0 g/dL in non-pregnant females
11.0 to 16.0 g/dL in children — this range can vary with age
greater than 10.0 g/dL during pregnancy

If a person’s levels fall below these thresholds, they have anemia. However, low hemoglobin alone does not always diagnose the cause of anemia.

Some potential causes of anemia include:

iron deficiency
chronic disease
thalassemia, a blood disorder that affects red blood cell production
lead poisoning
hypothyroidism
liver disease
some medications

Some factors, such as diet, activity level, certain medications, or menstrual periods, may affect the results of this test.

A doctor may ask questions about a person’s health history, medications, and symptoms to interpret the results. People may require further testing to rule out certain diseases or determine the underlying cause of any abnormal results.

Share on PinterestShortness of breath, irregular heartbeat, and chest pain may be symptoms of low hemoglobin.

Typical symptoms of low hemoglobin include:

weakness
shortness of breath
dizziness
fast, irregular heartbeat
pounding in the ears
headaches
cold hands and feet
pale or yellow skin
chest pain

Older people or people who lack iron in their diets can be at risk of developing anemia.

People who perform vigorous exercise are also at greater risk, as exertion can lead to a breakdown of red blood cells in the bloodstream. Someone who is menstruating or pregnant may also be at increased risk of developing anemia.

People who have chronic health conditions, including autoimmune conditions, liver disease, thyroid disease, and inflammatory bowel disease, may have lower hemoglobin levels, which increases the chances of developing anemia.

Hemoglobin levels increase when a person needs more oxygen in their body. Consequently, someone who has lung or kidney disease, smokes, or is dehydrated, may be at risk of increased hemoglobin levels.

Share on PinterestEating iron-rich foods may help to prevent anemia.

While many types of anemia are not preventable, eating iron-rich foods, such as beef, dark green leafy vegetables, dried fruits, and nuts can prevent anemias caused by iron or vitamin deficiencies.

Meat and dairy are good sources of vitamin B12. Citrus juices, legumes, and fortified cereals contain folic acid.

The American Society of Hematology recommends against taking an iron supplement unless a doctor advises doing so.

Also, smoking cessation — for those who smoke — and drinking plenty of water can help avoid high hemoglobin levels.

Find out about good sources of iron here.

Anemia treatment varies depending on the cause of the condition. Changes in diet or dietary supplements can help people who have iron- or vitamin-deficiency anemias.

If another condition is the cause of anemia, treating the underlying disease will often alleviate the issue.

Medications and blood transfusions are treatment options for aplastic anemia, and antibiotics may help with hemolytic anemia.

Polycythemia is a lifelong condition with no cure, but medication can help manage symptoms.

Similarly, sickle cell disease requires ongoing management of symptoms. A stem cell transplant may cure the disease in some people, but it also poses significant risks.

Learn more about how doctors can treat polycythemia vera.

The outlook for anemia depends on its cause.

Iron-deficiency anemia, vitamin-deficiency anemia, and anemia from blood loss have a good outlook with treatment. People with iron deficiency typically need treatment for at least 3 months to rebuild their iron stores.

Sickle cell disease, polycythemia, and some other chronic diseases that can cause anemia, such as kidney disease, will require ongoing management and treatment.

Untreated anemia can cause:

preterm labor, birth complications, and anemia in the baby if a person is pregnant
heart disease, including heart attack
restless leg syndrome
multiorgan failure and, eventually, death

Older people and people with comorbidities are more vulnerable to serious complications.

Hemoglobin is an iron-rich protein in red blood cells that helps to transport oxygen throughout the body.

High hemoglobin levels could be due to polycythemia. This is where the body makes excess red blood cells and can lead to clots, heart attacks, and stroke without treatment.

Anemia is a group of medical conditions that undermine the body’s ability to get oxygen. This is because people with anemia do not have enough hemoglobin or red blood cells to distribute oxygen throughout the body.

It is important to diagnose the cause of anemia and treat it. Dietary changes, nutritional supplements, blood transfusions, symptom management, and treatment for underlying medical conditions may help. People with symptoms of anemia, a history of anemia, or at high risk of anemia should consult a doctor for regular anemia testing.

Read the article in Spanish.

Anemia in children | City Children’s Hospital

What is anemia

Anemia is a decrease in the total concentration of red blood cells and hemoglobin in the blood. The task of red blood cells is to deliver oxygen to the tissues of the body. Therefore, with a decrease in their number, the body suffers from the so-called hypoxia – lack of oxygen. Children are especially sensitive to a decrease in hemoglobin.

According to statistics, anemia occurs in 15% of children. Anemias are very different – some are associated with a lack of B vitamins, others – with a lack of folic acid. But the vast majority of anemia develops due to iron deficiency. These anemias are called iron deficiency, and they are the most common (about 90% of all anemias). Let’s talk about iron deficiency anemia today.

Causes and symptoms of anemia

Causes of iron deficiency anemia are divided into three groups.

The first is the situation associated with blood loss. This includes bleeding from the gastrointestinal tract, menstrual bleeding, and any other blood loss.

The second group includes the lack of iron. And although this is possible only when fasting, this happens in children. For example, when vegetarian parents intentionally deprive their child of meat food – the main source of heme iron.

The next group of causes is iron malabsorption. With some diseases of the stomach or intestines, after abdominal operations on the gastrointestinal tract. The fact is that iron is absorbed mainly in the duodenum and in the upper sections of the small intestine. Therefore, any problems with these parts of the gastrointestinal tract can provoke anemia.

Anemia can also occur when there is insufficient production of red blood cells, impaired functioning and premature destruction of red blood cells.

Your child is pale, gets tired quickly, complains of muscle weakness, dizziness. These are the first signs of anemia. Such situations are typical for both schoolchildren and preschool children. Attentive parents will immediately go to see the doctor. If anemia is started, then soon your child will become inactive, cracks will appear in the corners of the mouth, the tongue will become smooth and glossy, “flies” will flash before the eyes. There will be perversions in food desires, especially the desire to lick nails and other metal objects.

Your task as parents and as your doctor is to identify its type, causes and eliminate iron deficiency.

Diagnosis and treatment of anemia

In order to confirm the diagnosis of anemia, you need to pass an elementary general blood test (from a finger). According to its results, it will be seen how critical the condition of the child is. If hemoglobin (HGB) is between 90 and 110, it is mild anemia; 90-70 – anemia of moderate severity; a score below 70 is a warning sign of severe anemia. Pay attention to the number of erythrocytes in the blood (RBC). Their norm for children is 4.0-7×1012 (depending on age).

A very important indicator of anemia is the color index of the blood. Normally, it should be equal to one. If its value is higher than 1.05, it becomes clear that anemia is caused by a deficiency of B vitamins or folic acid. If the CPU is less than 0. 85, iron deficiency anemia is suspected. There are other criteria based on which the diagnosis of IDA is made, but we will provide their analysis to a knowledgeable doctor.

After the diagnosis is made, the doctor must determine the cause of the anemia, and you must help him with this. Be sure to tell your doctor if suddenly your child does not eat meat or fish, if he has gastrointestinal diseases (ulcerative and pre-ulcerative bowel conditions). It is very important to find out and eliminate the root cause of anemia, otherwise no treatment will give results, and after a few months anemia will reappear. Treatment of anemia should be comprehensive. Diet can eliminate only a small lack of iron, more serious situations require complex treatment that combines both a special diet and medications. But more on that later.

Treatment should ONLY be prescribed by a doctor. And it is better if it is a qualified hematologist. An excess of iron is just as dangerous for a child’s body as its deficiency. Therefore, self-medicating, you run the risk of seeing overdose symptoms – cramps, vomiting and diarrhea.

Modern iron preparations are available in easy to take forms such as syrups, drops and even chewable tablets. For mild anemia, oral medication is sufficient. Moreover, it is better to drink them with juice, and be sure to take them outside of food! If the anemia is severe, hospital treatment, parenteral administration of drugs, and sometimes even blood transfusion are indicated. Therefore, do not risk the health of children and, at the slightest suspicion, seek medical help.

Nutrition for anemia. Prevention of anemia

Understanding the mechanism of absorption of iron from various sources is important for the formation of the correct principles of nutrition for a child. The fact is that in red meat, liver and eggs, iron is contained in a quickly digestible form – the so-called heme (heme) iron. Plant foods (legumes, buckwheat, pomegranates) are a storehouse of non-heme (non-heme) iron, which is absorbed worse. Therefore, the child’s menu must contain meat (beef, rabbit – 30 grams per day), sea fish, eggs (1-2 pieces), berries and juices rich in ascorbic acid. It is ascorbic acid and animal protein that improve the absorption of iron (with simultaneous use 3 times!). While whole milk and dairy products should be eaten separately from meat, fish and eggs.

It used to be believed that apples contained a lot of iron. This is not true, since there is exactly as much iron in apples as there is in buckwheat. Just apples contain ascorbic acid, which improves the absorption of iron. Therefore, you do not need to force-feed the child with apples, and if he does not like berries and juices, it is better to give the good old ascorbic vitamin. By the way, few people know that dried porcini mushrooms (35 mg per 100 g), seaweed (16 mg per 100 g), cocoa powder (15 mg per 100 g), liver (9mg per 100 g).

Don’t get sick!

Iron deficiency anemia. What tests to take

The most common form of anemia is iron deficiency anemia (IDA), which is diagnosed by clinical and laboratory testing.

Anemia – a decrease in the amount of hemoglobin, manifested by a decrease in its concentration in the blood. Regardless of the form of anemia (the reason for its development), the result of the disease is insufficient oxygen supply to the body (hypoxia).

Iron deficiency anemia (IDA) accounts for more than 80% of all forms of anemia and remains one of the most pressing and widespread nutritional problems worldwide. The main reasons for the development of IDA are unbalanced nutrition, malabsorption of substances in the gastrointestinal tract (GIT) and periodic blood loss (menstruation, gastric ulcer, parasitic diseases, etc.). The risk group for developing iron deficiency includes:

women – due to periodic physiological blood loss;
pregnant and breastfeeding women – due to the high need for micro and macro elements;
children and adolescents – due to the high needs of the growing organism;
elderly people – due to the high prevalence of chronic blood loss (for example, through the gastrointestinal tract) or changes in daily diet.

Tests for iron deficiency anemia

The first test that patients usually take is General or clinical blood test. In this analysis, attention is paid to erythrocyte indicators in the CBC:

HGB hemoglobin concentration;
RBC count;
Hematocrit HCT refers to the relative proportion of red blood cells in whole blood.

As well as the most important indicators of differential diagnosis of forms of anemia:

MCV, mean erythrocyte volume;
MCH – the average content of hemoglobin in an erythrocyte characterizes the average mass of hemoglobin in an erythrocyte. This indicator has replaced the color indicator;
MCHC – the average concentration of hemoglobin in an erythrocyte reflects the average mass of hemoglobin per unit volume of an erythrocyte;
RDW – erythrocyte distribution width by volume – an indicator of the heterogeneity of the erythrocyte size.

In IDA and other hypochromic anemias (anemia of chronic diseases, sideroblastic anemia), MCV, MCH, MCHC values are reduced, while in megaloblastic anemias (B12- and folate deficiency anemia), on the contrary, they are increased. RDW rises sharply in IDA, but in another hypochromic thalassemia anemia, RDW remains normal or slightly elevated.

Peripheral blood smear for iron deficiency anemia

However, patients with low levels (less than 120 g/l in women and 130 g/l in men) need a comprehensive laboratory study to understand the nature and causes of anemia.

The following tests are carried out in the CIR Laboratory for the diagnosis of iron deficiency anemia:

Serum iron ;
Transferrin ;
Ferritin ;
Unsaturated Serum Iron-Binding Capacity (LWBC, Latent Serum Iron-Binding Capacity, LWBC) ;
Percent saturation of transferrin .

All these indicators reflect how iron is exchanged in the body. It depends on factors such as iron intake from food or drugs, absorption of iron, absorption of iron inside the body and its exchange.

Indicators of iron metabolism in various diseases

Disease	Serum iron	OZhSS and Transferrin	NWSS	Transferrin saturation percentage	ferritin
IDA	downgraded	promoted	promoted	downgraded	downgraded
Hemolytic anemia	promoted	normal / low	low/normal	promoted	promoted
Sideroblastic anemia	normal/increased	normal / low	low/normal	promoted	promoted
Thalassemia	promoted	low/normal	low/normal	elevated/normal	promoted
Anemia of chronic disease	downgraded	promoted	promoted	downgraded	promoted
Hemochromatosis	promoted	downgraded	downgraded	promoted	promoted

What if hemoglobin is normal?

Latent iron deficiency is a stage in the development of IDA, when in the absence of adequate replenishment of the amount of iron necessary for the body, symptoms of its deficiency appear. This is also called “sideropenic syndrome”. The latent period is characterized by the preservation of hemoglobin and tissue iron funds with a decrease in its reserves, hence it follows that with a latent iron deficiency, a decrease in serum ferritin is observed at a normal concentration of hemoglobin in the blood.

However, the indicators of ferritin and transferrin are proteins of the “acute phase of inflammation” and may be accompanied by an increase and decrease in the concentration in the blood during the inflammatory process, respectively. Therefore, in order to exclude a false interpretation of the dynamics of ferritin and transferrin levels during the inflammatory process, it is also recommended to simultaneously study other specific markers of inflammation:

C-reactive protein ;
Interleukin 6

In addition to indicators of iron metabolism, tests can be prescribed for the diagnosis of anemia:

Vitamin B12 (cyanocobalamin)
Folic acid

A decrease in these indicators may indicate B12 or folate deficiency anemia.

Reticulocytes

Reticulocytes are future erythrocytes. A blood test for reticulocytes shows how blood is restored during anemia, thus. the test helps in the differential diagnosis of anemia, as well as in monitoring the progress of treatment.

Erythropoietin

Erythropoietin – a hormone that controls the development of red blood cells (erythropoiesis), stimulates the formation of red blood cells in the bone marrow. The analysis speaks not only about the differentiation of anemia, but also about the severity of anemia.