Introduction

Hemoglobin (often abbreviated as Hgb or Hb) is a vital protein found in red blood cells. Its primary role is to transport oxygen from the lungs to the body’s tissues and return carbon dioxide from the tissues to the lungs for removal. This article delves into the intricacies of hemoglobin, its measurement, normal levels across different age groups and genders, and its significance in health and disease.

What is Hemoglobin?

Hemoglobin consists of four protein molecules, known as globulin chains, interconnected. In adults, it comprises two alpha-globulin chains and two beta-globulin chains. However, in fetuses and infants, it includes two alpha chains and two gamma chains, with the gamma chains gradually replaced by beta chains as the infant matures. Each globulin chain contains an essential iron-containing porphyrin compound called heme, which houses an iron atom crucial for oxygen and carbon dioxide transport in the blood. The presence of iron in hemoglobin also gives blood its characteristic red color. Hemoglobin also plays a pivotal role in maintaining the shape of red blood cells, which is crucial for their function and smooth passage through blood vessels.

Measuring Hemoglobin

Hemoglobin levels are typically measured as part of a complete blood count (CBC) test, which requires a blood sample. Various methods exist for hemoglobin measurement, many of which involve automated machines designed for blood analysis. These machines break down red blood cells to release hemoglobin into a solution. Cyanide-containing chemicals then bind with hemoglobin to form cyanomethemoglobin. The amount of hemoglobin is determined by measuring the absorption of light (specifically at a wavelength of 540 nanometers) as it passes through the solution.

Normal Hemoglobin Levels

Hemoglobin levels are expressed in grams (gm) per deciliter (dL) of whole blood, with a deciliter equal to 100 milliliters. Normal hemoglobin ranges vary depending on age and gender:

• Newborns: 17 to 22 gm/dL
• One week of age: 15 to 20 gm/dL
• One month of age: 11 to 15 gm/dL
• Children: 11 to 13 gm/dL
• Adult males: 14 to 18 gm/dL
• Adult females: 12 to 16 gm/dL
• Men after middle age: 12.4 to 14.9 gm/dL
• Women after middle age: 11.7 to 13.8 gm/dL

These values may slightly differ between laboratories. It’s noteworthy that pregnant women should maintain hemoglobin levels within the normal range to mitigate the risk of complications, including stillbirth (high hemoglobin) or premature birth and low-birth-weight infants (low hemoglobin).

Low Hemoglobin Levels (Anemia)

Low hemoglobin levels, often referred to as anemia, result from a reduced number of red blood cells. Numerous factors can cause anemia, including blood loss (e.g., injury, surgery, bleeding), nutritional deficiencies (e.g., iron, vitamin B12, folate), bone marrow disorders (e.g., cancer), chemotherapy-induced suppression of red blood cell production, kidney failure, and abnormal hemoglobin structure (e.g., sickle cell anemia or thalassemia).

High Hemoglobin Levels

Elevated hemoglobin levels can occur in individuals living at high altitudes or those who smoke. Dehydration can also temporarily raise hemoglobin measurements, which normalize upon rehydration. Less common causes of high hemoglobin levels include advanced lung disease (e.g., emphysema), certain tumors, a bone marrow disorder called polycythemia rubra vera, and the misuse of the drug erythropoietin (Epogen) for blood doping purposes, typically practiced by athletes seeking to increase oxygen availability by artificially elevating red blood cell production.

Defective Hemoglobin: Sickle Cell Disease

Sickle Cell Disease (SCD) is a genetic condition characterized by defective hemoglobin quality. This condition results in abnormal hemoglobin and the formation of sickled red blood cells. These misshapen cells struggle to traverse small blood vessels, leading to insufficient oxygen delivery to body tissues. Individuals with sickle cell disease may experience symptoms like body aches, chest pain, bone pain, shortness of breath, skin ulcers, fatigue, strokes, blindness, and delayed growth and puberty. When only one defective hemoglobin gene is inherited, the condition is milder and referred to as sickle cell trait.

Hemoglobin Deficiency in Thalassemia

Thalassemia encompasses a group of hereditary conditions characterized by quantitative hemoglobin deficiency. These conditions arise when the body fails to produce sufficient globulin molecules, prompting the production of less compatible globulin molecules. The severity of thalassemia depends on the type of deficient globulin chain, the quantity of deficient globulins, and the extent of underproduction. While mild forms may only lead to mild anemia, severe deficiency can be life-threatening.

Hemoglobin A1c Test

Hemoglobin A1c (HbA1c) serves as an indicator of blood sugar control in individuals with diabetes over the past three months. As blood glucose circulates, it binds to hemoglobin. Normal HbA1c levels range between 4% to 5.9%. An HbA1c of 6% corresponds to an average blood sugar level of about 135 mg/dL over the preceding three months. A 1% increase in HbA1c above 6% represents an average blood sugar increase of approximately 35 mg/dL over 135 mg/dL.

Increasing Hemoglobin Levels

Methods to increase hemoglobin levels depend on the underlying causes, which include decreased red blood cell production, increased red blood cell destruction, and blood loss. Approaches may include:

• Blood transfusions
• Erythropoietin (a hormone stimulating red blood cell production)
• Iron supplements
• A diet rich in iron and cofactors like vitamin B6, folic acid, vitamin B12, and vitamin C (found in fish, vegetables, nuts, cereals, peas, and citrus fruits)

It’s essential to consult a physician before pursuing any treatment for low hemoglobin levels, as inappropriate or excessive treatments can cause additional health problems. Iron supplements should also be kept out of the reach of children to prevent iron poisoning, which can be fatal.