720 North Tustin Avenue
Suite 104
Santa Ana, CA 92705-3606
Phone: (714) 565-1032
Fax: (714) 565-1035

Jeremy E. Kaslow, MD, FACP, FACAAI Physician and Surgeon
Board Certified Internal Medicine

NOTICE TO CONSUMERS
Medical Doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

Red Blood Cell count (RBC)

The primary reason to assess the RBC is to check for anemia and to evaluate normal erythropoiesis (the production of red blood cells). The mature red blood cell (also known as an erythrocyte) carries oxygen attached to the iron in hemoglobin. The number of red blood cells is determined by age, sex, altitude, exercise, diet, pollution, drug use, tobacco/nicotine use, kidney function, etc. The clinical importance of the test is that it is a measure of the oxygen carrying capacity of the blood.

Optimal values for an adult male are 4.70-5.25 million/mm3 and for an adult female are 4.00 to 4.50 million mm3.

The number of red blood cells is increased in:

Chronic Respiratory Insufficiency

  • Emphysema
  • Respiratory distress
  • Living at a high altitude
  • Cystic fibrosis

Non-respiratory

  • Adrenal cortical hyperfunction
  • Polycythemia vera(often a hereditary problem)
  • Anabolic Metabolism (testosterone use)

The number of red blood cells is decreased in:

  • Iron deficiency (should see a low MCV)
  • Vitamin B6, B12, and/or Folic Acid deficiency (should see a high MCV )
  • Chronic Disease (Liver dysfunction (liver function tests might show abnormalities, kidney dysfunction (chemistry tests and the BUN, creatinine may be abnormal).
  • Hereditary anemia(s).
  • Free radical pathology.
  • Toxic metals.
  • Catabolic Metabolism

Hemoglobin (Hgb)

Hemoglobin is what gives the red color to your blood. It contains the iron, which carries the oxygen to the cells. The hemoglobin level indicates the amount of intracellular iron; hence, its value in determining anemia. Hemoglobin is the most abundant protein found within the red blood cell. Because there is a wide range of hemoglobin levels in healthy individuals, a hemoglobin value above or below the average may not necessarily be a problem. For example, an infant has a higher hemoglobin level, which soon declines to a level somewhat lower than the adult levels. Low values persist through childhood with a tendency to lower values in the elderly. Hemoglobin must be evaluated with the hematocrit (HCT), RBC, and the RBC indices (MCV) to determine if there is fact anemia and the type of anemia. The causes of low hemoglobin may need serum iron studies, globulin levels, uric acid, ceruloplasmin (copper), and ferritin (iron stores) to be determined.

Optimum values for an adult male is 14.0 to 15.0 g/dl and for an adult female is 13.5 to 14.5 g/dl.

Hemoglobin is increased in:

  • Dehydration as might occur with prolonged or severe diarrhea.
  • Emphysema, severe asthma, and other forms of long-standing respiratory distress.
  • Macrocytosis (deficiency of B6, B12, folic acid, or hypothyroid)
  • Adrenal cortex overactivity.
  • Polycythemia vera.
  • High altitude adaptation
  • Splenic hypofunction
  • Testosterone supplementation

Hemoglobin is decreased in:

  • Digestive inflammation (with hidden or obvious blood loss) as might occur with parasites, colitis, hemorrhoids, etc.
  • Free radical pathology.
  • Adrenal cortical hypofunction
  • Hereditary anemia(s)
  • Hemodilution (pregnancy, edema)
  • Blood loss (lung, gastrointestinal/hemorrhoids/ulcers/colitis, uterine/menses, in urine via kidneys, hemorrhage)
  • Deficiency (protein malnutrition, iron, copper, Vitamin C, Vitamin B1 (thiamine), folic acid, B12)
  • Chronic disease (liver, kidney, rheumatoid arthritis, Carcinoid, etc.)
  • Bone marrow insufficiency (infiltration with tumor or tuberculosis, toxic or drug induced hypoplasia)

According to a large study group of nutritional experts, after reviewing thousands of blood chemistries patients with normal to low normal hemoglobin and hematocrit levels are generally more active and healthy than patients with high or high normal levels.

Hematocrit (HCT)

The hematocrit is one of the most precise methods of determining the degree of anemia or polycythemia (excessive amount of red blood cells).  The hematocrit represents the volume of red blood cells in 100ml of blood and is therefore reported as a percentage.  A low hematocrit and hemoglobin usually indicates decreased production, excessive loss, or destruction of red blood cells. Anemia is not a disease, but a term indicating insufficient hemoglobin to deliver oxygen to the cells. It is always a secondary phenomenon.

Optimum values in an adult male are 42.0 to 48.0% and in an adult female is 39.0 to 45.0%.

The conditions associated with an increased or decreased hematocrit are the same as for hemoglobin. In addition, it has been suggested that an elevated hematocrit may be due to spleen hyperfunction, and a reduced hematocrit may indicate low thymus function.

Mean Corpuscular Volume (MCV)

The MCV relates to the average size of the red blood cell. MCV increase or decrease along with an increase or decrease in MCH is a significant finding for folic acid and/or B12 need (increase) or iron, copper or vitamin B6 need (decrease). MCV and MCH should always be viewed together.

Optimum values 87.0 to 92.0 cu. microns.

The MCV is increased in:

  • Hereditary anemia(s).
  • Megaloblastic Anemias (pernicious, folic acid deficiency, B12 deficiency)*
  • Reticulocytosis (acute blood loss response; reticulocytes are immature cells with a relatively large size compared to a mature red blood cell)
  • Artifact (aplasia, myelofibrosis, hyperglycemia, cold agglutinins)
  • Liver disease
  • Hypothyroidism
  • Drugs (anti-convulsants)
  • Zidovidune treatment (AIDS)

The MCV is decreased in:

  • Copper deficiency
  • Low stomach acid (Hypochlorhydria).
  • Vitamin C insufficiency.
  • Vitamin B6 deficiency.
  • Rheumatoid arthritis.
  • Toxic effects of lead and other toxic elements.
  • Hereditary (thalassemias, sideroblastic)
  • Iron deficiency (blood loss, parasites, poor intake, low stomach acid, etc)
  • After a splenectomy
  • Hemolytic anemia

* Note: Because anemia due to folic acid and B12 anemia are difficult to differentiate without more sophisticated tests, any supplementation of B12 should always be accompanied by Folic Acid as well, and vice versa. It has been said that an iron:copper ratio <1 on a hair-mineral analysis is indicative of both folic acid and B12 need. Folic acid and B12 should be considered in all cases of nerve inflammation, nerve degeneration blood sugar problems, nerve irritation and vegetarian diets. Often with either folic acid or B12 deficiency, there is low stomach acid. It is important to treat all of these deficiencies rapidly and effectively to prevent permanent damage.

Consider B6 and magnesium need whenever P.M.S. is present.

Mean Corpuscular Hemoglobin (MCH)

The amount of hemoglobin in a single red blood cell is indicated by the MCH. It is a variation of the MCV measurement.

Optimum values: 28.0 to 32.0 micrograms.

The MCH is increased in and decreased in the same conditions as the MCV.

Mean Corpuscular Hemoglobin Concentration (MCHC)

The average hemoglobin concentration per unit volume (100 ml) of packed red cells is indicated by MCHC.

Optimum values: 32 to 35 %.

MCHC is increased in and decreased in the same conditions as the MCV. Two exceptions - in spherocytosis, the MCHC is elevated but not in pernicious anemia.

Platelet Count

Platelets are fragments of cells that participate in clotting. They initiate repair of blood vessel walls. People whose platelet count is low bleed easily after brushing their teeth, small cuts, surgeries, etc. Many will show small red dots ("petechiae") that do not blanch on the lower legs when platelet counts are low. Consider platelets an acute phase reactant to infection or inflammation. When extreme, further evaluation of the bone marrow or spleen is indicated.  

Optimum values: 230,000 to 400,000 mm3.

Platelets are often increased in:

Reactive

  • Infection
  • Acute blood loss
  • Disseminated carcinoma
  • Splenectomy
  • Various free radical pathologies (tissue damage, chronic inflammation, surgery)

Thrombocythemia

  • Polycythemia Vera
  • Myeloproliferative Disorders
  • Chronic Granulocytic Leukemia
  • Hemolytic anemia(s)
  • Myelosclerosis
  • Essential (without known cause)

Platelets are often decreased in:

Decreased Production

  • Marrow depression (aplastic anemia, radiation, chemotherapy, drugs)
  • Marrow infiltration (acute leukemia, carcinoma, myelofibrosis, multiple myeloma)
  • Megaloblastic anemia (B12 and/or folic acid deficiency)
  • Congenital

Increased Destruction

  • Immunologic (ITP, infectious mononucleosis (EBV), SLE, Lymphoma, CLL)
  • Drugs (chemotherapy, heparin)
  • Dilution due to overhydration
  • Coagulation disorders ( DIC, septicemia, hemolytic-uremic syndrome, TTP, large hemangiomas, heart valve, eclampsia)
  • Hypersplenism
  • Platelet aggregation or large platelets
  • Rubella
  • Liver dysfunction (cirrhosis).
  • Idiopathic Cytopenic Purpura (ITP), a condition possibly related to viral infection, autoimmunity or chemical toxin.

Random Distribution of Width (RDW)

The RDW stands for Random Distribution of red cell Width. This value tells how consistent are the size of the red blood cells. Newly made cells (reticulocytes), B12 and folic acid deficient cells are larger than iron deficient cells. This is an electronic index that may help clarify if an anemia has multiple components. The high RDW helps determine if there is only a B12 and/or folic acid deficiency (with normal RDW showing the red cells are mostly the same size) or with concomitant iron deficiency (a high RDW due to small and large red blood cells).

Optimal Range: 13

The RDW is often increased in:

  • B12 and Pernicious anemia
  • Folic acid anemia
  • Iron deficiency anemia combined with other anemia
  • Hemolytic anemia
  • Transfusions
  • Sideroblastic anemia
  • Alcohol abuse
  • Various less common and hereditary anemias

The RDW is often decreased in:

  • Iron deficiency anemia (blood loss, parasites, poor iron absorption, etc.)
  • Vitamin B6 anemia
  • Rheumatoid arthritis
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