Hemoglobin is in. Reduced and increased hemoglobin in the test results: what does this mean? Deviations from the norm

It is the main component of red blood cells and gives them their characteristic red color. This is one of the most important components of blood, since the main function of hemoglobin is to transport oxygen from the alveoli of the lungs to the cells of the whole body, as well as carbon dioxide in the opposite direction (to the lungs).

One red blood cell contains approximately 400,000,000 hemoglobin molecules.

The formula of the hemoglobin molecule is C 2954 H 4516 N 780 O 806 S 12 Fe 4.

The molecular weight of hemoglobin is 66,800 g/mol (66.8 kDa).

The structure of hemoglobin

The structure of hemoglobin in a human erythrocyte

The structure of the hemoglobin molecule is simple - it contains only 2 components:

1. Globin

Heme

Heme is a natural pigment that contains a compound of porphyrin and iron. The total proportion of heme in the structure of hemoglobin is only 4%. Iron, which is part of hemoglobin, has a valence of Fe2+.

Heme structure: porphyrin molecule and Fe2+

The general formula of heme is C 34 H 32 O 4 N 4.

The molecular weight of heme is 616.5 g/mol.

The presence of strong oxidizing agents (free radicals) in the blood leads to the oxidation of divalent iron to ferric iron (Fe3+). Heme in this case turns into hematin, and hemoglobin itself into methemoglobin. Only divalent iron is able to attach oxygen and transport it from the alveoli of the lungs to the tissues of the body, therefore the oxidation of iron in heme and the formation of methemoglobin has a very negative effect on the ability of red blood cells to transport oxygen, which leads to hypoxia.

Antioxidants (vitamins C, A, E, selenium, etc.) prevent the formation of methemoglobin by inactivating free radicals. But the already formed hematin can be converted back into heme only by special enzymes - NADH and NADPH methemoglobin reductase. It is these enzymes that reduce Fe3+ in methemoglobin to Fe2+ hemoglobin.

Globin

Globin is an albumin protein that makes up 96% of the mass of hemoglobin and consists of 4 chains - 2 α and 2 β.

The structure of the globin protein - alpha and beta chains

Each alpha chain of globin consists of 141 amino acids, and the beta chain consists of 146 amino acids. In total, there are 574 amino acid residues in the hemoglobin molecule.

Human globin, unlike animal globin, does not contain the amino acids leucine and cystine.

The molecular weight of globin is 64,400 g/mol (64.4 kDa).

The alpha and beta chains of globin form 4 hydrophobic pockets, in which 4 hemes are located. It is the hydrophobic pocket of the globin protein that allows the heme iron to attach oxygen without oxidizing, i.e. without transition to Fe3+. Three amino acid residues are of particular importance in the formation of the hydrophobic pocket: proximal histidine, distal histidine and valine.

CBC indicators are among the most important studies that allow you to quickly perform a primary diagnosis and assess the health status of the subject. The main indicators of the general analysis include hemoglobin level.

Hemoglobin is a protein respiratory blood pigment. The main role of this substance is to transport O2 and carbon dioxide, as well as maintain normal blood pH.

This substance is found in erythrocyte blood cells. The main components of hemoglobin are protein parts - globins and iron-containing porphyrin regions - hemes. Fe (iron) in hemoglobin is in 2-valence forms.

The ability of hemoglobin to actively attach and remove oxygen molecules is determined precisely by heme molecules containing Fe.

Hemoglobin is synthesized by red bone marrow cells (RBC). An important condition for the synthesis of hemoglobin CMC is the intake of the required amount of proteins and Fe (iron) into the body.

The destruction of hemoglobin molecules is carried out by phagocytic mononuclear cells (the spleen, liver, and bone marrow contain the largest number of these cells).

What is hemoglobin indicated in a blood test?

In blood tests, hemoglobin is designated as Hb or Hgb.

On average, the total amount of hemoglobin in the blood of women ranges from 120 to 140 g/l, and in men - from 135 to 160.

The reasons for the increase in values ​​are considered to be erythremia, blood thickening due to dehydration (the so-called false increase based on hemoconcentration), living in mountainous areas and excessive use of tobacco products.

Reduced values ​​can cause various anemias and acute blood loss.

Types of hemoglobin in humans

This substance can be presented in the form of oxyhemoglobins, methemoglobins, carboxyhemoglobins, carbohemoglobins, deoxyhemoglobins and myoglobins. Also, fetal hemoglobins are secreted, which are normally recorded in the fetus.

In patients with diabetes (diabetes mellitus), glycosylated hemoglobin can be detected, which is one of the most important indicators of the course of diabetes mellitus.

Oxyhemoglobins

Oxyhemoglobin is the physiological form of hemoglobin that contains the 2-valent form of iron and is characterized by a high ability to bind oxygen. Oxyhemoglobin in the body is responsible for the active transport of oxygen to tissue and organ structures.

Most oxyhemoglobin is found in arterial blood (it is this compound that causes its scarlet color).

After oxyhemoglobin gives up oxygen in the tissues, it becomes deoxyhemoglobin.

Carboxyhemoglobins

Carboxyhemoglobins are compounds of hemoglobin and carbon dioxide. Venous blood contains the largest amount of this compound (this determines its dark cherry color).

Against the background of carbon monoxide poisoning, physical forms of Hb can be converted into carbohemoglobin. This form of Hb is not capable of transporting oxygen and decomposes extremely slowly, leading to the development of oxygen starvation in organs and tissues (in this regard, carbon monoxide is an extremely toxic compound for humans).

When the body is exposed to various oxidizing agents (peroxide, nitrites, etc.), hemoglobin can turn into pathological methemoglobin, which contains 3-valent iron and is incapable of fully transporting oxygen molecules.

Myoglobins

Myoglobin is a compound similar in structure to hemoglobin. It is found in muscle tissue and contains more than fourteen percent of the body's total oxygen reserves.

Most myoglobin is found in the heart muscle.

This compound plays an important role in providing muscle structures with the oxygen necessary for their full functioning. At the same time, myoglobin is able to create a temporary oxygen reserve, which is used by the body in the event of a decrease in the content of oxyhemoglobin in the blood (reduced oxygen capacity of the blood).

Fetal hemoglobins

They belong to the fetal type of hemoglobin. It is actively produced from the sixth to seventh week of development of the unborn baby. After the tenth week of development, it replaces the fetal type of hemoglobin and becomes the main form of fetal hemoglobin.

During the last months of pregnancy and the first weeks (sometimes months) of life, this form of hemoglobin is replaced by the normal adult type of hemoglobin.

Normally, fetal forms in adults can account for less than one percent of all hemoglobins in the body.

In newborn babies, determining the levels of this compound plays an important role in determining the degree of fetal maturity, diagnosing hemolytic anemia in newborns, etc.

In adults, the appearance of fetal hemoglobin in the blood can be observed with leukemia, severe hypoxia, etc.

What is hemoglobin for?

This connection performs the following functions:

• binds oxygen and transports it to tissue and organ structures;
• binds carbon dioxide and utilizes it from organs and tissues;
• provides a buffer function, maintaining normal blood pH;
• provides an oxygen supply in the muscles (due to myoglobin, muscles are able to continue to contract for some time even under conditions of oxygen starvation).

Physiological changes in Hb

Normally, Hb is slightly higher in men than in women.

Also, athletes and residents of mountainous regions experience a physiological increase in the level of red blood cells and Hb.

In women, a natural decrease in Hb may be observed during pregnancy. At the same time, this indicator should be strictly monitored by the attending physician. A pronounced decrease in the indicator (anemia) can cause miscarriage, fading of pregnancy, lead to fetal hypoxia, intrauterine growth retardation, etc.

Too high a hemoglobin level during pregnancy is fraught with blood thickening, high risks of microthrombosis, the development of severe late gestosis (preeclampsia and eclampsia), miscarriage, fetal hypoxia (due to thrombus formation in the placental vessels), etc.

Does hemoglobin drop during menstruation?

If a patient’s Hb drops below the normal range after menstruation, she needs to undergo a comprehensive examination by a gynecologist.

A common gynecological cause of decreased Hb is dysfunctional uterine bleeding and inter-cycle bleeding.

Chronic light blood loss often leads to moderate and severe anemia, which is difficult to treat.

How to test hemoglobin at home?

At home, hemoglobin levels are not checked.

However, some symptoms may suggest reduced hemoglobin in the blood.

Symptoms of decreased performance may include:

• feeling of constant drowsiness, muscle weakness, weakness, causeless fatigue;
• yellowish, sallow or grayish skin tone;
• peeling, dry skin;
• seizures in the corners of the lips;
• dry mucous membranes;
• dry and cracked lips;
• brittle nails;
• alopecia;
• dry, split and dull hair;
• desire to eat crayons, raw meat products, soil;
• perverted sense of smell (unpleasant odors seem pleasant);
• muscle pain, etc.

Critical level of hemoglobin in the blood in women and men

How to donate blood for hemoglobin, on an empty stomach or not?

Blood is donated on an empty stomach. A few days before blood sampling, it is necessary to avoid drinking alcohol. It is not recommended to smoke before blood collection.

It should also be noted that many drugs, when used for a long time, lead to a decrease in laboratory parameters. Reduced hemoglobin levels may occur in patients treated with phenytoin, meprobamate, chlorpromazine, quinine, quinidine, captopril, procainamide, carbutamide, tobutamine, nitrofurans, insulin, sulfonamides, levodopa, cyclophosphamide, mercaptopurine, methotrexate, vincristine, amphotericin B, chlorine. amphenicol, penicillins , non-steroidal anti-inflammatory drugs, etc.

How does alcohol affect hemoglobin in the blood?

Alcoholic drinks, when consumed excessively, lead to a decrease in the levels of this substance. A pronounced decrease in Hb is observed in patients with alcoholic hepatic cirrhosis.

The only alcoholic drink that can increase Hb is high-quality natural red wine.

At the same time, red wine to increase hemoglobin levels should be taken in combination with a special diet (meat products, nuts, dried fruits, etc.) and no more than fifty milliliters per day.

Reason for changes in hemoglobin level in blood tests

An increased rate can be recorded in patients with erythrocytosis, erythremia, renal polycystic disease, malignant kidney disease, overproduction of androgenic hormones, dehydration and blood thickening, physiological erythrocytosis in newborns, congenital heart defects, etc.

A decrease in this indicator is observed in individuals with anemia of various origins (posthemorrhagic, iron deficiency, folate deficiency, sickle cell, etc.), bleeding, chronic renal pathologies accompanied by a decrease in the synthesis of erythropoietins, hepatic cirrhosis, erythrocyte hemolysis, autoimmune pathologies, malignant neoplasms, some infections, etc.

How to normalize Hb values?

Patients with anemia may be prescribed Fe, folic acid, vitamin B12, erythropoiesis stimulants, a special diet (increased consumption of dried fruits, meat, chocolate, nuts, etc.)

Severe anemia may require blood transfusions.

Patients with chronic posthemorrhagic anemia should eliminate the cause of bleeding (ulcer, prolonged menstruation, hemorrhoids, capillary fragility, etc.).

The main function of red blood cells is to transport oxygen to tissue cells. The most important role in this process is played by organic pigment; it gives red blood cells their scarlet color. Hemoglobin is distinguished by its high activity of combining iron molecules with oxygen molecules. Due to this, oxygen is transferred to the tissues. Hemoglobin is produced by bone marrow cells. Cells that have completed their functions in the liver are destroyed, turning into the pigment bilirubin, and are excreted in the feces through the intestines.

Sometimes, in case of serious illnesses and poisoning, the membrane of red blood cells may be destroyed and hemoglobin may mix with the blood plasma. In this case, the blood completely loses its function and the person dies.

But too high a hemoglobin level in the blood is also bad. In this case, there is reason to think about concomitant diseases - diabetes mellitus, cardiopulmonary failure, heart defects, sometimes this is a sign of cancer. But this does not apply to residents of high mountain areas, athletes, pilots and climbers, since in this way the body adapts to increased physical activity.

The doctor must consider all factors together and prescribe appropriate treatment based on this. For iron deficiency anemia, iron supplements are prescribed, and when the cause of the increase in hemoglobin levels is determined, treatment for the underlying disease is prescribed.

How to normalize hemoglobin levels

If your hemoglobin is low, you need to eat more. To do this, introduce more proteins into the diet - meat, especially veal, fish, and beef liver. Large amounts of protein are found in legumes, grains and cereals. But you don’t need to eat only vegetarian food; protein must be present. Juices are very useful after a heavy meat lunch, as they accelerate the breakdown of protein. Dark buckwheat honey stimulates the production of hemoglobin well, but the consumption of tea and coffee should be reduced, they lower hemoglobin. It is better to replace them with juice or compotes.

With increased hemoglobin, blood viscosity often increases; the doctor should also prescribe medications to thin it. Self-medication in such cases is dangerous.

Treating elevated hemoglobin levels with an appropriate diet is also possible. It is necessary to limit the consumption of fatty meat foods, eat more fish and seafood.

Hemoglobin is an extremely important part (protein) of red blood cells that carries oxygen molecules to all parts of the body. Low and high levels of this protein can negatively affect our health. In this article, we will look at the symptoms of high or low hemoglobin, as well as health factors or types of diseases that increase or decrease the level of hemoglobin in our blood.

This is the second article in a series of articles on hemoglobin

1. Hemoglobin: reasons for low or high levels

The article is based on the findings of 37 scientific studies

The article quotes the following research authors:

• Department of Medicine, Milan, Italy
• University Hospital Miguel Served, Zaragoza, Spain
• Rush Alzheimer's Center, Chicago, USA
• Department of Sports Medicine, University of Bayreuth, Bayreuth, Germany
• Center for Hematology and Oncology, Munich, Germany
• Department of Hematology, Nottingham City Hospital, UK
• and other authors.

Please note that the numbers in parentheses (1, 2, 3, etc.) are clickable links to peer-reviewed scientific studies. You can follow these links and read the original source of information for the article.

Low hemoglobin level

Having a slightly low hemoglobin (Hb) level is usually not accompanied by symptoms. However, any decrease in hemoglobin or the number of red blood cells (RBCs) leads to a decrease in exercise endurance, even when hemoglobin levels are in the range of 12-13 g/dL.

A deficiency of hemoglobin and/or red blood cells is called anemia.

According to the World Health Organization (WHO), anemia is defined by a hemoglobin level of less than 12 g/dl in women and less than 13 g/dl in men .

Although the ability of body tissues to obtain oxygen remains proportional to the level of circulating hemoglobin in the blood, people with chronic anemia develop a compensatory mechanism to improve oxygen delivery to body tissues. This mechanism maintains a sufficient volume of oxygen for the vital functions of organs until hemoglobin decreases to 7-8 g/dl.

Severe anemia is defined as hemoglobin levels below 7 g/dL .

Symptoms of low hemoglobin

Signs of low hemoglobin (anemia) include: [,]

• Fatigue and general weakness
• Irritability
• Dizziness
• Headache
• Poor concentration
• Shortness of breath on exertion
• Rapid heartbeat
• Rapid onset of fatigue with low physical activity
• Cold hands and feet (impaired ability to maintain body temperature)

It is often not easy to tell if you are anemic. But people with low hemoglobin exhibit several designated symptoms at the same time. In addition, they often become accustomed to their symptoms and consider them normal.

High hemoglobin level

You are considered to have high hemoglobin if your hemoglobin level is greater than 16 g/dL (women) or 18 g/dL (men) [,]. This condition is called polycythemia.

Higher hemoglobin levels increase blood viscosity. The relationship between the increase in hemoglobin value and viscosity is linear up to 16 g/dl. Above this level, the relationship becomes exponential - a small increase in hemoglobin leads to a large increase in blood viscosity.

As soon as the hemoglobin concentration reaches values ​​above 18 g/dl, the viscosity of the blood reaches such a level that it impairs blood circulation in small blood vessels, and the delivery of oxygen to the organs and tissues of the body is sharply reduced.

This condition often manifests as a bluish discoloration of the skin and impaired mental function as a result of cerebrovascular accident. And all these signs are very similar to the course of severe anemia. In addition, due to poor blood circulation, the risk of blood clots increases significantly.

A study of people with chronic mountain sickness demonstrated that, due to the combination of high altitude and poor lung function, long-term survival with hemoglobin levels above 20 g/dL is not possible.

Increased hemoglobin has several causes, but is usually the result of these 2 mechanisms

• Increased production of blood cells. This occurs as compensation when the oxygen throughput in the blood is disrupted.
• Decreased plasma volume (the liquid part of the blood).

Symptoms of elevated hemoglobin

Signs of high hemoglobin include[,]:

• High blood pressure
• Itchy skin
• Headache
• Dizziness
• Ruddy complexion
• Blurred vision
• Burning, tingling, or stabbing sensations and numbness in the extremities.

Factors that increase hemoglobin

Height

Living at a higher altitude increases hemoglobin levels. This is because low oxygen levels at high altitudes increase blood cell production. As a result, the amount of hemoglobin increases along with the cells in order to deliver more oxygen to the body’s tissues. [ , ]

For example, studies have shown that in healthy men and women, hemoglobin increased within 7 days of ascending to an altitude of 5,260 meters, but returned to normal levels within the same 7 days of descending to an altitude of 1,525 meters (the study involved 21 volunteer).

Athletes often use high altitude to increase their hemoglobin levels and improve athletic performance. Increasing hemoglobin through high altitude training is considered a legal manipulation in various endurance sports, in contrast to the illegal use of erythropoietin (EPO), androgens (more on these below), and autologous blood transfusions.

The increase in hemoglobin contributes to increased endurance, which is proportional to the increase in the oxygen capacity of the blood.

Long-term living at altitudes between 2,100 and 2,500 meters increases hemoglobin levels and studies show that this effect persists for 2-3 weeks after descending to sea level.

High hemoglobin is also a sign chronic mountain sickness.

Residents of the Himalayas, but not residents of the Andes mountains (South America), were able to adapt to high altitude by reducing the level of hemoglobin in their bodies. Because of this, they rarely suffer from chronic mountain sickness. These differences in adaptation are due to the very long time that the inhabitants of the Himalayas were forced to adapt to higher altitudes. At high altitude, the inhabitants of the Andes mountains have been inhabited for 9,000 to 12,000 years, but the Himalayan plateau was filled with people more than 50,000 years ago.

Residents of Tibet (the high-altitude part of it) by lowering hemoglobin levels were able to increase their physical endurance and reduce the risk of blood clots, chronic mountain sickness, pre-eclampsia during pregnancy, and reduce infant mortality rates (study involving 1,749 women). [ , ]

Smoking

Carbon monoxide (CO) in tobacco smoke competes with oxygen to bind to hemoglobin, and CO is 210 times more efficient at this bond than oxygen.. To compensate for the “loss” of part of the hemoglobin bound by carbon monoxide, the body begins to produce red blood cells, which contribute to the growth of hemoglobin. This condition is often called smoker's polycythemia.

Respiratory and cardiovascular diseases

Lung diseases and cardiovascular diseases, which contribute to a decrease in the amount of oxygen in the blood and also stimulate an increase in hemoglobin levels.

In addition to smoking, increased hemoglobin also appears as the body's response to conditions of low oxygen in the blood. Such conditions include chronic obstructive pulmonary disease (COPD) or sleep apnea.

Polycythemia vera

Polycythemia vera is a bone marrow disease in which there is an overproduction of red blood cells (and high hemoglobin as a result).

Today there is no specific treatment for this disease. However, it is possible to treat symptoms and increase life expectancy.

In women with elevated hemoglobin levels greater than 16 g/dL or in men greater than 18 g/dL, polycythemia vera may be suspected. It is more common in older people.

People with polycythemia vera may not have any symptoms. However, sometimes, they may experience an itching sensation after taking a warm bath, weakness, weight loss, development of gouty arthritis and peptic ulcers. In many cases, this condition is caused by a mutation in the JAK2 gene.

Due to a gene mutation, the disease is often hereditary; children of the first degree have a 5-7 times higher risk of developing polycythemia vera compared to the general population. Additionally, high incidence rates of polycythemia vera are common among descendants of Ashkenazi Jews.

Long-term risks of this disease include progression to acute leukemia or severe bone marrow damage.

Dehydration

A decrease in plasma volumes (the liquid part of the blood) contributes to an increase in the relative values ​​of hemoglobin. .

Any condition that results in fluid loss, such as dehydration or severe burns, results in relatively high hemoglobin levels.

Severe dehydration can raise hemoglobin concentrations by 10-15%.

In a short period of time, there is a transient increase in hemoglobin levels, the values ​​of which are restored over the next 24 hours.

The increase in hemoglobin during physical activity is associated with a decrease in the volume of fluid in plasma (the liquid part of the blood), the replenishment of which does not occur intensively enough during exercise.

Regular exercise, on the other hand, reduces hemoglobin levels by increasing blood volume.

Erythropoietin

Testosterone and other hormones

Testosterone stimulates the production of red blood cells and increases hemoglobin levels, especially if there is a lot of testosterone or it comes from outside in high doses.

Androgens (male hormones) stimulate the production of blood cells. They do this by increasing the production of erythropoietin, which stimulates bone marrow function and increasing the amount of iron incorporated into red blood cells. .

Other hormones that increase red blood cell production include cortisol, growth hormone And insulin-like growth factor.

Kidney disease

Wilms tumor, other types of kidney cancer, and polycystic kidney disease - increase the number of red blood cells and hemoglobin.

A kidney transplant can work in a similar way. The study found that 10 of 59 kidney transplant patients who survived more than 3 months after surgery had high hemoglobin.

Factors that reduce hemoglobin

Iron deficiency

Red blood cells require large amounts of iron to produce hemoglobin. Actually, More than half of all iron in the body is contained in hemoglobin.

Iron deficiency lowers hemoglobin levels and leads to anemia when the body's iron stores are depleted.

In the absence of major bleeding, Iron deficiency anemia usually develops slowly over months or years.

Establishing a diagnosis of iron deficiency anemia can be similarly time-consuming, especially if the amount of iron in the diet helps maintain hemoglobin in the normal range.

In developed countries, 4-20% of the population suffers from iron deficiency anemia, while in developing countries these numbers range from 30-48%.

Deficiency of minerals and vitamins

In addition to iron deficiency, anemia can develop when there is a decrease in the intake of other vitamins and minerals, such as vitamin A, vitamin B9 (folic acid), vitamin B12, selenium, zinc, or copper. All of these vitamins and minerals are important for the production of blood cells.

Vitamin A deficiency

Vitamin A deficiency can lead to anemia because this substance is important for the production of blood cells and the binding of iron. [ , ]

Vitamin A increases erythropoietin production(EPO), a stimulant of red blood cell production. Vitamin A deficiency is common in developing countries but rare in developed countries.

The study found that children aged 6 to 59 months after birth who received a high dose of vitamin A showed increased-normal hemoglobin levels and had a reduced risk of developing anemia (study of 2,397 Ethiopian children).

Another study found that in Moroccan schoolchildren, vitamin A supplementation increased hemoglobin by an average of 0.7 g/dL and reduced the prevalence of anemia from 54% to 38% (81 schoolchildren in the study).

Mothers with vitamin A deficiency exhibit lower hemoglobin and a higher incidence of anemia. They also give birth to babies with lower hemoglobin levels (200 Egyptian mothers took part in the study).

Folic acid (vitamin B9) levels

Deficiency of folic acid (vitamin B9) is another major cause of anemia.

Folate deficiency anemia occurs due to poor nutrition, impaired intestinal absorption, increased need for this vitamin (for example, during pregnancy), when taking certain medications, or from hereditary diseases. [ , ]

Vitamin B12 and pernicious anemia

Lack of vitamin B12 (cobalamin) leads to anemia. It is usually caused by malabsorption in the intestines of people in developed countries due to their unhealthy diets, and insufficient dietary intake in people of developing countries.

Vitamin B12 deficiency occurs in 6% of people aged 60 years and older, while minor (mild) deficiency occurs in almost 20% of people in their lifetime.

Decreased absorption of vitamin B12 is often associated with diseases - pernicious anemia, autoimmune gastritis(inflammation of the stomach that prevents the absorption of vitamin B12). The prevalence of pernicious anemia in European countries is about 4% of the population, and is more common in older people.

Vitamin D increases hemoglobin levels

Research shows vitamin D deficiency increases risk of anemia(findings of a meta-analysis from 7 studies involving 5,183 adults).

Vitamin E helps increase hemoglobin

Vitamin E supplementation improved hemoglobin levels in mildly anemic healthy adults (study of 86 and 60 patients).

Zinc is important for maintaining iron levels

Zinc is necessary for the proper functioning of several enzymes that play a role in the production of iron from foods. That's why Zinc deficiency can lead to anemia.

The study found that patients with low zinc levels were more likely to have symptoms of anemia (86 study participants).

Copper promotes blood cell production

Copper deficiency causes disturbances in the production of blood cells and copper-deficiency anemia.

Too much tea

Green tea leaves naturally contain high levels of polyphenols, tannins, and aluminum. Both polyphenols and aluminum reduce iron levels and have been shown in a study to reduce hemoglobin levels in animals.

Tea interferes with the absorption of iron and can lead to iron deficiency anemia if consumed in very large quantities. However, this only happens if you consume excessive amounts of tea.

There is not a single case where a person developed anemia after daily intake of more than 1.5 liters of green tea (4 or more teaspoons of dry tea) for over 20 years.

Trained athletes, particularly in endurance sports, often have “sports anemia.”

This is not anemia in the clinical sense. In fact, athletes have increased total cell mass and hemoglobin levels in the blood compared to non-athletes. However, the relative decrease in hemoglobin is caused by an increase in the volume of plasma (the liquid part of the blood) in their blood.

Exercise also causes the destruction of old red blood cells in working muscles or during compression, such as in the soles of the feet during running.

The study found that decreases in hemoglobin were more common in people who trained for endurance compared to strength training or mixed training (endurance + strength) (747 athletes and 104 untrained adults participated).

Pregnancy

During a normal pregnancy, blood volume increases by an average of 50%. This rapid addition of blood volume begins in the first trimester. However, plasma volume (the liquid part of the blood) increases more than the mass of red blood cells, which leads to a relative decrease in hemoglobin levels in the first half of pregnancy. This condition is known as anemia of pregnancy.

This relative decrease in hemoglobin is most pronounced in women with a large fetus or in those who are planning twins.

It is important to note that although hemoglobin decreases, another value called mean erythrocyte volume (MCV), also obtained from a clinical blood test, does not change significantly during pregnancy.

Thus, a hemoglobin level below 9.5 g/dL in combination with an MCV (mean erythrocyte volume) value below 84 femtoliters (fl) is used to indicate true anemia (iron deficiency) in pregnancy. .

Bleeding

Blood loss can occur as a result of wounds and ruptured abscesses, heavy menstrual bleeding, or frequent blood donations (donation).

Women with heavy menstrual bleeding have lower hemoglobin levels and are more likely to have anemia (pilot clinical trial of 44 women).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to cause disruption of the intestinal integrity and bleeding in the upper part of the intestine. In addition, low doses of acetylsalicylic acid (aspirin, an NSAID) increase blood loss, and frequent use of aspirin can lead to anemia.

People who donate blood too frequently may also develop iron deficiency anemia. This is because blood donation removes large amounts of iron from the blood. It has been found that even a 56-day interval between donating blood as a donor is not sufficient to restore normal hemoglobin and iron values.

Monitoring your iron levels by measuring ferritin in your blood may also be helpful.

Medicines to lower blood pressure

Medicines used to lower blood pressure may also reduce hemoglobin levels. Usually these changes are small. However, in some cases, these drugs cause clinically significant degrees of anemia.

High blood pressure medications cause blood thinning (increased fluid levels in the blood), hemolytic anemia (abnormal destruction of red blood cells), and/or suppression of red blood cell production.

This most often occurs with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.

Increased weight (obesity)

A study of 707 teenagers found that it was associated with lower hemoglobin levels in girls.

Hypothyroidism

Anemia often accompanies thyroid disease.

Thyroid hormones stimulate the production of red blood cells, both directly and by increasing the production of erythropoietin (EPO).

Adding iron to standard treatment with thyroxine (one of two iodinated thyroid hormones) improves hypothyroidism better than thyroxine alone (study of 60 patients). [ , ]

This relationship between anemia and thyroid disease goes both ways, as decreased activity of the thyroid gland leads to anemia, and iron deficiency anemia reduces the level of thyroid hormones. .

Pregnant women with iron deficiency anemia are more likely to have hypothyroidism or subclinical hypothyroidism (study of 2,581 participants).

Chronic inflammatory diseases

Anemia of inflammation(also called anemia of chronic disease) – This commonly diagnosed anemia is associated with a worse prognosis and increased mortality in some diseases. [ , ]

This anemia of inflammation occurs when obesity, aging, kidney failure, cancer, chronic infections and autoimmune diseases.

This is mild to moderate anemia. Hemoglobin rarely decreases below 8 g/dL.

This state of the body is caused by immune activation (interleukin IL-6 increases the level of the hormone hepcidin, which reduces the amount of iron in the blood). [ , ]

The best treatment for this type of anemia is treatment of the underlying disease. When this is not possible, blood transfusions, intravenous iron, and medications that stimulate red blood cell production may be used, which may improve the condition.

This type of anemia can be treated by activating AMPK, an AMP-activated protein kinase.

Rheumatoid arthritis

Anemia is one of the symptoms of rheumatoid arthritis. It is estimated that 30-60% of patients with rheumatoid arthritis are anemic .

Additionally, people with high disease activity have lower hemoglobin levels (study of 89 patients).

Inflammatory bowel diseases

Anemia is one of the most common complications of IBD (). [ , ] This affects the quality of life and ability to work, and also increases the frequency of hospitalizations of patients.

The prevalence of anemia in IBD is variable and ranges from 6-74%, depending on the study.

Gluten intolerance (celiac disease)

Celiac disease affects about 1% of the population. Anemia is the most common symptom of celiac disease, affecting 32-69% of adults with gluten intolerance. Conversely, among patients with unexplained iron deficiency anemia, 5% of them are confirmed to have celiac disease.

Anemia in celiac disease is characterized by impaired absorption of iron and loss of blood due to damage to the intestinal walls. Even after switching to a gluten-free diet, it takes 6 to 12 months for most patients to recover from anemia.

In particular, half of the patients with celiac disease still had iron deficiency anemia and low hemoglobin even after one to two years on a gluten-free diet. .

Patients with celiac disease often benefit from intravenous iron supplementation.

The mechanism of development of anemia in chronic kidney disease (https://jasn.asnjournals.org/content/23/10/1631)

Chronic kidney disease

Anemia also often develops as a complication of chronic kidney disease(CKD). The severity of anemia is proportional to the degree of kidney dysfunction.

Kidney damage results in the inability to produce the required amount of erythropoietin (EPO), a kidney hormone, and erythropoietin is known to stimulate the production of blood cells. Therefore, hemodialysis patients receive substances that stimulate the production of red blood cells along with iron, which helps increase hemoglobin levels.

The FDA recommends 10-12 g/dL as a hemoglobin level goal in patients with (CKD). Higher hemoglobin values ​​(>13 g/dL) should be avoided as these hemoglobin values ​​have been shown to be associated with poor clinical outcome in CKD.

Liver diseases

Among patients with chronic liver disease, more than 75% show signs of anemia. It is mainly associated with acute or chronic intestinal bleeding, which leads to iron deficiency anemia.

(NAFLD) is one of the most common liver diseases worldwide, and one third of adults with NAFLD are iron deficient. [R].

Also, some medications used to treat anemia can cause liver disease. For example, anemia is often associated with pegylated interferon alfa-2a and ribavirin, which are used in the treatment of chronic hepatitis C virus infection.

Helicobacter infection (H. pylori)

Anemia often accompanies infection helicobacter(H. pylori). More than 50% of patients with unexplained iron deficiency anemia may have an active infectionhelicobacter (H. pylori).

Bacterium H. pylori increases iron loss due to:

• Bleeding caused by inflammation of the stomach, peptic ulcer or stomach cancer.
• Reduced absorption of the gland, which also occurs due to inflammation of the stomach.
• Decreased vitamin C levels (vitamin C usually helps with iron absorption).
• Iron loss caused by iron uptake by bacteria helicobacter. [ , ]

Most sick people with H. pylori-associated anemia completely recovered from anemia only after successful anti-bacterial treatment. (study of 84 patients).

Lead poisoning

Lead poisoning impairs hemoglobin production and reduces the survival of red blood cells. .

Higher blood lead concentrations were associated with anemia in 60 children who were exposed to lead from contaminated drinking water.

Finally, factory workers with chronic low-level lead exposure had a higher risk of developing anemia (533 men and 218 women in the study).

Cadmium poisoning

Cadmium causes anemia due to the destruction of red blood cells, iron deficiency and decreased production of erythropoietin (EPO).

Anemia and low erythropoietin levels are clinical signs of itai-itai disease, which is a condition caused by long-term cadmium intoxication in Japan.

Aflatoxin

Pregnant women with high levels of aflatoxin B1 in their blood greatly increased their chances of developing anemia (study of 755 women).

Congenital sideroblastic anemia

This is a genetic disorder that prevents the formation of red blood cells, leading to hemoglobin deficiency.

Some patients require regular blood transfusions, while others require sporadic blood transfusions when their bone marrow is suppressed, such as by a viral infection.

In some cases, the condition of congenital sideroblastic anemia improves by taking vitamin B6.

Sickle cell anemia

Sickle cell anemia causes inflammation, blood clots, destruction of red blood cells, and oxygen deficiency, which ultimately leads to damage to the body's organs. Occasional exacerbation of the disease causes severe pain, attacks of pulmonary failure and cases of stroke.

About 240,000 children are born each year with sickle cell disease, most of whom live in Africa. Only 20% of these children survive to their second birthday. The median survival rate for patients with sickle cell disease in the United States is about 42 years.

There is an important reason why this disease is so common in Africa. Namely, people who have an abnormal copy of hemoglobin S are resistant to malaria [,].

Carriers of one copy of the hemoglobin S gene usually have 40% hemoglobin S and 56-58% normal hemoglobin in their blood. They typically live without symptoms and require severe oxygen deprivation for sickle cell disease symptoms to occur.

Approximately 8% of African Americans carry this altered hemoglobin variant. Hydroxyurea has been approved for the treatment of adult patients with sickle cell disease.

Thalassemia

Thalassemia is a disorder resulting from a combination of more than 300 known mutations in the beta chain or a smaller number of mutations in the alpha chain of hemoglobin. These mutations are common in the Mediterranean, Southeast Asia and China. About 60,000 children are born each year with this disease.

People with thalassemia have varying degrees of anemia. In more severe cases, such as beta thalassemia, there is an inability to maintain hemoglobin levels greater than 6.5 g/dL.

The disease is treated with transfusion, bone marrow transplantation or gene therapy. Like sickle cell hemoglobin S carriers, thalassemia mutation carriers are also resistant to malaria. Therefore, these mutations are quite common in Africa.

Scheme of the development of iron deficiency anemia (https://blogs.nejm.org/now/index.php/iron-deficiency-anemia/2015/05/08/)

Cancer

Anemia is a common symptom of cancer. It is diagnosed in 50% of cases of various cancers.

There are several causes of cancerous anemia:

• Internal bleeding
• Increased destruction of red blood cells
• Lack of nutrition
• Bone marrow damage
• Radiation therapy and chemotherapy
• Erythropoietin deficiency (EPO)
• Inflammation [ , ]

Three years after cancer diagnosis, patients with advanced anemia have twice the risk of mortality compared to patients without anemia.

Low hemoglobin levels tend to be most common in people with advanced cancer (study of 888 patients).

HIV infection and anti-HIV drugs

Anemia is an important factor in the treatment of HIV-infected patients. It is estimated to be common in 10% of people with HIV and asymptomatic in 92% of AIDS patients.

A large study of 32,867 HIV-infected adults and adolescents in the US found that the risk of death was 170% greater in those who showed persistent anemia compared with those whose anemia was compensated.

Malaria

Malaria threatens almost half the world's population. This is an important factor, but not entirely understood as a cause of anemia.

Young children are at high risk of developing severe forms of anemia associated with malaria, especially in countries where transmission of malaria to children at birth is present and relapses are common.

This type of anemia can be effectively treated with early and effective antimalarial therapy.

Enlarged spleen

People with an enlarged spleen may develop anemia due to increased destruction of red blood cells in the spleen.

An enlarged spleen can be caused by infections, liver disease, cancer, or inflammatory diseases.

Autoimmune anemia

Autoimmune anemias are caused by increased destruction of red blood cells, which are attacked by autoantibodies. This is a rare condition that accompanies a number of diseases.

Aging

People are more likely to develop anemia as they get older. Anemia was found in 11% of men and 10% of women over age 65, and in 26% of men and 20% of women over age 85 (NHANES III, 39,695 people).

A decrease in hemoglobin levels occurs in the eighth decade of life and appears to be part of the. However, anemia in older adults is associated with a range of adverse outcomes, including functional dependence, dementia, falls, heart disease, and death. .

In approximately 50% of cases, anemia in older people has reversible causes (can be corrected), including iron and vitamin B12 deficiency, as well as chronic renal failure.

Factors that interfere with hemoglobin function

Methemoglobin

In healthy people, methemoglobin (metHb) accounts for 1 to 2% of total hemoglobin. Some drugs and toxins are known to increase methemoglobin levels.

Carbon monoxide (carbon monoxide)

Carbon monoxide (CO) binds to hemoglobin 210 times more than oxygen. Inhalation of large amounts of carbon monoxide (carbon monoxide) leads to toxic poisoning. .

When carbon monoxide binds hemoglobin, it is not possible to further bind oxygen. This causes tissue damage due to oxygen deficiency.

When carbon monoxide binds 20% of hemoglobin, signs of brain damage and heart damage develop. . When 40-60% of hemoglobin binds, a person falls into an unconscious state, coma may develop and death may occur.

Carbon monoxide poisoning is treated by oxygenating the blood or giving a blood transfusion.

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