What It Means to Get High or Low Results > Personalabs

The hematocrit or HCT blood test measures the proportion of red blood cells to white blood cells, platelets, and plasma. 

High HCT blood test values (usually over 44% to 50%) indicate dehydration and conditions that cause RBC overproduction. Alternatively, extremely low hematocrit results may indicate anemia or other blood disorders that affect RBC formation (erythropoiesis) or destruction (hemolysis). 

Know more about the concerning levels of HCT and what the test results tell you when you read on.

Pro Tip: Hematocrit and other parts of the complete blood count (CBC) reveal essential information about your health. If you wish to learn more about what your blood test means, book a virtual consultation to speak to a healthcare provider. 

High HCT Meaning 

If your HCT blood test result shows high hematocrit, over 50% for men and 44% for women, it suggests that you have more red blood cells or erythrocytes due to an underlying health condition. It could also indicate that blood plasma is in critically low volume. 

Symptoms of high hematocrit include:

• Fatigue
• Dizziness 
• Headaches
• Vision problems
• Skin blushing or flushing

Causes of High HCT

Dehydration

If you have high HCT, you are likely to be dehydrated. In this case, you may not necessarily be producing too many RBCs. Instead, your blood has a low volume of plasma which stems from a lack of proper hydration. 

Lung Disease

Conditions affecting lung function, such as chronic obstructive pulmonary disease (COPD), can affect the organ’s ability to obtain oxygen. To compensate for the oxygen shortage, your body will produce more RBCs. If you have symptoms of pulmonary disorders, your doctor may order additional laboratory tests, including lung function blood tests. 

Heart Disease

People with heart disease are prone to high hematocrit and hemoglobin. As the heart cannot function fully to facilitate blood circulation, your body will counteract the said loss with increased erythrocyte production. Thus, an HCT blood test also provides additional information about your risk for cardiovascular diseases, making it a key part of heart health blood tests. 

Cancer

The primary cancer type that drives your bone marrow to produce excessive red blood cells is called polycythemia vera. Although extremely rare, this blood cancer slows down blood circulation, and leads to an enlarged spleen, increased blood clotting, and other life-threatening blood-related complications. Naturally, it also elevates your normal hematocrit levels. 

On the other hand, kidney cancer also influences erythrocyte production since it releases the protein (erythropoietin) that prompts the process. This can be further confirmed by additional tests, such as a red blood cell count, biopsy, MRI, etc. 

Did You Know? Several cancers can be detected by biomarkers screened through a blood test. In some cases, these cancers are first spotted through routine exams. Learn more about the types of cancer diagnosed through blood testing. 

Treatment for Elevated HCT

Lowering your high HCT will depend on its cause. For example, if it’s due to dehydration, your healthcare provider may recommend rehydration therapy. If your test result goes extremely above the normal range for HCT, your doctor may push for phlebotomy, wherein blood is extracted to reduce red blood cell count. 

Low HCT Meaning 

To get an HCT below the normal hematocrit range (less than 41% for men and 36% for women) indicates low red blood production or a high rate of destruction, potentially due to an underlying illness. 

The most common cause of low hematocrit is anemia, characterized by a reduced number of healthy red blood cells. You may spot anemia through the following symptoms:

• Fatigue
• Dizziness 
• Chest pain
• Headaches 
• Pale complexion
• Trouble breathing
• Cold hands and feet
• Irregular heartbeat (arrhythmia) 

Causes of Low HCT

Anemias 

As mentioned above, low HCT typically signals anemia, which can be due to a lack of nutrients, such as that in iron-deficiency anemia, or genetic factors like what’s causing sickle cell anemia and aplastic anemia. Additional blood tests are needed to verify the condition, including the anemia profile blood test. 

Blood Loss

Women who experience excessive menstrual bleeding are likely to have low HCT. In the same way, those who suffer from bacterial ulcers caused by H. pylori and other similar disorders leading to internal bleeding can also expect decreased HCT in their blood test. 

Did You Know? It’s possible to experience blood loss without seeing blood in your stool, as the naked eye does not easily detect it. Get the fecal occult blood test to determine if you have chronic digestive bleeding.

Thalassemia 

Thalassemia is an inherited blood disorder wherein your body fails to produce enough hemoglobin, a crucial protein in the red blood cell. As a result, RBCs are low, indicated by low HCT and erythrocyte count.  

Kidney Problems

Your kidneys don’t just filter wastes from the blood. They also produce the protein erythropoietin, which signals the production of RBCs. Hence, disorders like chronic kidney disease (CKD) and other significant kidney problems lead to low secretion of erythropoietin, resulting in inadequate RBCs. 

Inflammatory Diseases

Conditions like lupus and rheumatoid arthritis, characterized by increased inflammatory activities, negatively influence RBC formation and maturation. Similarly, inflammatory bowel disease (IBD) may also promote anemia leading to low HCT as it affects the absorption of iron, copper, vitamin B12, and other fundamental nutrients for erythropoiesis.  

Cancers

Leukemia and lymphoma are two types of cancers that directly impact bone marrow function. Hence, with these underlying conditions, you may likely get low HCT in your blood test and undergo further testing. 

Treatment for Low HCT

If low HCT is due to iron-deficiency anemia, your doctor may recommend supplements and certain lifestyle adjustments. Learn more about iron deficiency anemia and its physical impact, especially among women.  

On the other hand, if the condition is linked to more complex disorders like cancer, blood disease, CKD, etc., your healthcare provider will need more information to form an accurate diagnosis, entailing other types of assessment. Only then will your doctor prescribe a treatment that covers the process in which HCT is brought to its normal range.

How Is Hematocrit Measured?

Calculating hematocrit involves measuring the ratio of red blood cells through a reading device. When using a capillary tube, the length of the RBC packed length volume is compared to the total length of the blood sample. 

It is imperative to have the analysis within 10 minutes of the sample collection, as the erythrocyte layers can mix with the other blood components and platelets begin to clot. 

How and When Is It Done?

Your doctor will likely order an HCT blood test if you exhibit symptoms of anemia, blood loss, dehydration, and other blood disorders. As part of the CBC test, it also provides critical information on other disorders, such as cancer, lung disease, kidney disease, liver problems, and cardiovascular diseases.  

Unlike the other tests involved in CBC, wherein the blood samples can be collected through finger pricking, an HCT blood test will require a venous blood sample. This is drawn from the veins at the back of your elbow and should only be performed by a licensed phlebotomist. HCT measurement needs more volume of blood for accurate processing and analysis. 

Additionally, an HCT blood test alone does not require fasting or other special preparations prior to blood collection. But if it is part of a more extensive test or if you’re taking another test simultaneously, you may have to abstain from consuming food, drinks, and certain medications. 

Pro Tip: Venipuncture, the process of inserting a syringe needle into your vein for blood collection, can be a little discomforting. If you are anxious about your lab test appointment, read our tips on how to calm yourself when getting blood drawn. 

Frequently Asked Questions

What level of HCT is concerning?

The normal hematocrit range for men is 41% to 50%, while women should have 36% to 44%. HCT test values that go above or below these ranges signal problems in the blood ranging from anemia to blood loss for low HCT percentage and dehydration to blood cancer for high lab values. Either way, see your doctor for a proper diagnosis and additional lab tests. 

Can high HCT cause fatigue?

Feeling exhausted all the time is part of the symptoms of high HCT. The increased volume of RBCs causes the blood to be thicker and move slower, affecting the rate of oxygen distribution to cells. As a result, your brain receives less oxygen, making you tired and sleepy. 

Does low HCT mean dehydration?

It’s the other way around. Low HCT suggests conditions like anemia and other blood disorders, but it’s high HCT that indicates dehydration. The lack of sufficient fluid in your body results in blood plasma having less volume, which increases the percentage of RBC. 

Did You Know? Aside from an HCT blood test, other ways to detect dehydration include a urinalysis and the electrolyte blood test panel. Treatment for severe dehydration includes administering IV fluids and oral rehydration solution (ORS). 

The Bottom Line 

An HCT blood test helps detect various health conditions, especially blood disorders. However, without fully understanding what your test results mean may lead to misconceptions about the severity of the abnormality. In addition, it’s important to understand that a hematocrit blood test alone will not suffice as far as diagnosis goes. It’s always the best course of action to speak to your doctor whether by setting up an appointment, either for a physical or virtual consultation.

Hematocrit | Sight Diagnostics

Definition, Test, Low vs High Levels and Causes

What is hematocrit

Hematocrit (HCT) is the calculated volume percentage of red blood cells (erythrocytes) in your blood. Hematocrit is also called packed cell volume (PCV) or erythrocyte volume fraction.

Human blood contains red blood cells, white blood cells, and platelets suspended in a liquid called plasma. The word hematocrit means to separate blood. In a hematocrit test, the red blood cells are separated from the rest of your blood cells and plasma.

Hematocrit is important because red blood cells are essential to your survival. They contain a vital protein component called hemoglobin that binds to oxygen, which fuels all the cells in your body.

When red blood cells pass through your lungs, they bind to and transport oxygen to various cells in your body. On their way back to your lungs, they carry carbon dioxide to be exhaled. Hematocrit is a significant measurement as it can identify whether you have sufficient red blood cells for oxygen transportation and delivery.

If your doctor suspects that you have a blood disorder such as anemia or polycythemia (too many red blood cells), your doctor may order a hematocrit test to check your red blood cells.

How to measure hematocrit with a test?

The original method for hematocrit measurement is the macrohematocrit (Wintrobe hematocrit tube) method.

It uses a narrow glass tube and a centrifuge machine. The centrifuge separates the blood into three main layers: red blood cells, white blood cells, and platelets, in that order from the bottom up. At the very top, there’s a small layer of blood plasma. The macrohematocrit method carries the risk of measuring trapped plasma as part of the red blood cell layer, which erroneously elevates the hematocrit percentage.[1]

A newer method is the microhematocrit method, which uses a capillary tube instead of a narrow glass tube and requires a smaller quantity of blood and less time. The microhematocrit method traps less plasma because the diameter of the capillary tube is smaller than the Wintrobe hematocrit tube. So the percentage of hematocrit is more accurate in the microhematocrit method than in the macrohematocrit method.[1:1]

Both procedures require the technician to manually measure the length of the layers. The technician calculates hematocrit as the length of the packed red blood cell layer divided by the length of total cells and plasma. This ratio is then multiplied by 100 to give a certain percentage.

Today, these two methods have been largely succeeded by an automated hematology analyzer where the hematocrit test is obtained as part of a complete blood count (CBC) laboratory test. The hematocrit is calculated indirectly from the average volume and the number of red blood cells.[2] The automated analyzer is the fastest method. However, automated analyzers may not be available in areas where resources are low.

In the microhematocrit method, a technician only needs a small sample of blood from a finger-prick. In the other methods, the technician draws blood from the inner side of your arm or the back of your hand. Before drawing blood for the measurement, the technician first cleans the surface from where your blood would be drawn. Next, using a needle, the technician draws your blood. Afterward, the technician covers the surface with gauze and a bandage.

What is a normal hematocrit level?

Due to differences in age and gender, the normal hematocrit is a range. Hematocrit results are reported as a percentage. The average hematocrit measurement for human beings is 45%, which means that the red cell volume contains 45 mL per 100 mL of blood.[3]

According to the Cleveland clinic, the general normal ranges for hematocrit are[4]:

• Male: 41% to 50%
• Female: 36% to 44%
• Newborn: 45% to 61%
• Infant: 32% to 42%

What does it mean if your hematocrit is high?

If your hematocrit is high, it means that you have more red blood cells than is considered healthy. 

High hematocrit may be caused by [4:1]:

• Heart disease
• Dehydration
• Scarring or thickening of the lungs
• Bone marrow disease
• Obstructive sleep apnea
• Smoking and chronic obstructive pulmonary disease (COPD)
• Carbon monoxide poisoning
• Testosterone use

A false high hematocrit may be reported if the patient has cryoproteins, significant leukocytosis, or giant platelets. Hematocrit measurement is critically high if it is greater than 67% (>67%).

What does it mean if your hematocrit is low?

If your hematocrit is low, it means that you have fewer red blood cells than is considered healthy.

Low hematocrit may be caused by[4:2]:

• Blood loss
• Leukemia or other bone marrow problems
• Iron and vitamin deficiency, including folate, vitamin B12, and vitamin B6
• Too much water in the body
• Kidney disease
• Thyroid abnormality
• Immune destruction of red blood cells

A false low hematocrit may be reported if the patient has microcytosis, in vitro hemolysis, or autoagglutinins. Hematocrit is considered critically low if it falls below 21% (<21%).

How to increase hematocrit?

In some cases, hematocrit is caused because of low iron levels. You can eat iron-rich foods and take a daily vitamin supplement to help prevent low hematocrit causes.

Food sources that are rich in iron include:

• Red meat
• Beef liver
• Chicken liver
• Fish and shellfish
• Soy products (tofu and edamame)
• Dried fruit
• Green leafy vegetables
• Nuts
• Beans
• Iron-fortified bread and cereals
• Eggs

Additionally, vitamin C helps with iron absorption. Therefore, also eat various foods that are rich in vitamin C, for example, citrus fruits. Do not drink coffee or tea with your meals because this decreases iron absorption.

Discover Sight’s Automated Hematology Analyzer

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Target hematocrit values ​​during therapeutic bloodletting in patients with polycythemia vera

PUBLICATIONS

Polycythemia vera (polycythemia vera) is a myeloproliferative disease in which there is an increased production of erythrocytes, granulocytes and platelets. The development of the disease is associated with a mutation (V617F) in the JAK2 tyrosine kinase gene. However, the JAK2V617F mutation is also found in half of patients with essential thrombocytosis, primary myelofibrosis, which reduces the specificity of this genetic disorder in the diagnosis of polycythemia vera.

There is no doubt that erythrocytosis plays a negative role in the development of blood stasis, platelet activation and hypercoagulability, endothelial damage (“Virchow’s triad”), however, the place of bloodletting in the treatment of polycythemia vera remains controversial.

The Polycythemia Vera Study Group (PVSG) compared bloodletting with radioactive phosphorus or chemotherapy. In the group of patients treated with bloodletting, there was a higher incidence of thrombotic complications, but in the other two groups there was an increased incidence of acute leukemia. It should be noted that the target hematocrit values ​​in this study were ≤ 52%.

The main reason for objections to bloodletting as a treatment is the difficulty of objectively assessing the total blood volume that increases in polycythemia (especially splenomegaly). The increase in plasma volume contributes to the “pseudonormalization” of hematocrit, and in some cases may make it difficult to recognize polycythemia according to the criteria of the World Health Organization; in such cases, it is advisable to exclude the JAK2V617F mutation.

If in vitro we estimate the hematocrit as the proportion of red blood cells in the blood volume, then in vivo the distribution of plasma and red blood cells in the bloodstream can vary depending on the type of vessels and the patient’s condition (presence of dehydration, tissue hypoxia). Hematocrit in vivo may differ significantly from values ​​obtained in the laboratory. The hematocrit measured in the analysis of peripheral blood, as a rule, is less than that observed in large vessels.

Marchioli R. et al. evaluated the effect of therapeutic bloodletting, hydroxyurea therapy or both in the general group of patients with polycythemia vera (n=365). Mortality from cardiovascular complications and thrombosis were compared when the target level of hematocrit was reached.

Figure 1. Kaplan-Meier curves for the primary endpoint of assessing the risk of death from cardiovascular complications or thrombosis in the Marchioli R. et al.

There were no significant differences in other outcomes.

Thus, when performing therapeutic bloodletting in patients with polycythemia vera, the target hematocrit values ​​should be

Currently, acetylsalicylic acid and hydroxyurea preparations are recommended for the prevention of arterial and venous thrombosis in polycythemia. But, as Marchioli R. et al. showed in their work, maintaining hematocrit is of the greatest importance for reducing the risk of thrombosis.

Source: Marchioli R., et al. Cardiovascular Events and Intensity of Treatment in Polycythemia Vera. NEJM – December, 2012

References:

1. Spivak JL. Polycythemia vera: myths, mechanisms, and management. Blood2002;100:4272-4290
2. Spivak JL, Barosi G, Tognoni G, et al. Chronic myeloproliferative disorders. Hematol Am Soc Hematol Educ Program 2003:200-24
3. Schafer AI. Molecular basis of the diagnosis and treatment of polycythemia vera and essential thrombocythemia. Blood 2006;107:4214-4222

Hematocrit increase on HRT and course

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Erythrocytes are blood cells containing hemoglobin. Their main function is to deliver oxygen to tissues and organs.
Hemoglobin is a protein found in red blood cells that exchanges oxygen between the lungs and body tissues.
Hematocrit is defined as the ratio of the total volume of all formed elements to the total volume of blood.
Erythropoiesis is hematopoiesis that occurs in the bone marrow due to stimulation by erythropoietin.
Testosterone partially contributes to the increase in erythropoietin levels and erythropoiesis.
Elevated hematocrit:
1. Load on the CCC.
2. Risk of thrombosis
Norm:cm
Hematocrit – 39-51%
Hemoglobin – 130-170 g / l
Erythrocytes – 4.2-5.7 10 per 12 / l
Prerequisites for an increase in hematocrit:
1. Smoking
2. Insufficient water intake
An increase in hematocrit, red blood cells and hemoglobin is called Erythrocytosis.
Erythrocytosis according to analyzes:
Hematocrit – more than 52-54%
Hemoglobin – more than 170-185 g / l
Red blood cells – more than 6 to 10 to 12 / l
Phlebotomy is bloodletting.