Is My Hemoglobin Level Normal or Not?

Q: recently had a blood test and my hemoglobin level was 12.2,its lower than normal and they said that i cant donate blood,what could be wrong,i feel normal,i don’t feel any problems with my body,do i need to take measures to increase it? i am a 19 year old Male

A: Hemoglobin Normal Ranges Chart

Anemia chart

There are A LOT of causes of anemia; some serious and some benign and easily treated. What this all adds up to is that there is no way for anyone to provide any advice regarding anemia without a thorough history and physical exam. 

Read: what is hgb on a blood test?

Just to give you an idea of just how many causes and treatments there are for anemia see the excerpt below. This is heavily edited/excerpted from UpToDate and is in no way a complete treatment of the subject. Suffice it to say, there is not one person here who can tell you why you are anemic or how to treat it. There are far too many causes and if you don’t know the cause, you can’t effectively treat it. 

Side note: No, you do not “…by definition have pernicious anemia.” That is a specific diagnosis that requires an evaluation of your B12 levels. You did not mention a B12 level so it is impossible to say whether you have pernicious anemia or not. 

“Anemia can be caused by one or more of three independent mechanisms: decreased red blood cell (RBC) production, increased RBC destruction, and blood loss. 

Anemia types

DECREASED RBC PRODUCTION

Anemia will ultimately result if the rate of RBC production is less than that of RBC destruction. The more common causes for reduced RBC production include:

  1. Lack of nutrients, such as iron, B12, or folate. This can be due to dietary lack, malabsorption (eg, pernicious anemia, sprue, intestinal disease), or blood loss (iron deficiency). 
  2. Bone marrow disorders (eg, aplastic anemia, pure RBC aplasia, myelodysplasia, tumor infiltration) 
  3. Bone marrow suppression (eg, drugs, chemotherapy, irradiation). 
  4. Low levels of trophic hormones which stimulate RBC production, such as EPO (eg, chronic renal failure), thyroid hormone (eg, hypothyroidism), and androgens (eg, hypogonadism). Acquired inhibitors of EPO or the EPO receptor have also been described as causes of anemia.
  5. The anemia of chronic disease/inflammation, associated with infectious, inflammatory, or malignant disorders, is characterized by reduced availability of iron due to decreased absorption from the gastrointestinal tract and decreased release from macrophages, a relative reduction in erythropoietin levels, and a mild reduction in RBC lifespan. 

INCREASED RBC DESTRUCTION

A RBC life span below 100 days is the operational definition of hemolysis. Hemolytic anemia will ensue when the bone marrow is unable to keep up with the need to replace more than about 5 percent of the RBC mass per day, corresponding to a RBC survival of about 20 days. Examples include: 

  1. Inherited hemolytic anemias (eg, hereditary spherocytosis, sickle cell disease, thalassemia major) 
  2. Acquired hemolytic anemias (eg, Coombs’-positive autoimmune hemolytic anemia, thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, malaria)

BLOOD LOSS

Iron deficiency in the United States and Western Europe is almost always due to blood loss. Blood loss is the most common cause of anemia and may take any one of a number of forms: 

  1. Obvious bleeding (eg, trauma, melena, hematemesis, menometrorrhagia) 
  2. Occult bleeding (eg, slowly bleeding ulcer or carcinoma). 
  3. Induced bleeding (eg, repeated diagnostic testing, hemodialysis losses, excessive blood donation)

In addition to the loss of RBCs from the body, which the bone marrow must replace, loss of the iron contained in these cells will ultimately lead to iron deficiency, once tissue stores of iron have been depleted. This usually occurs in males and females after losses of ≥1200 mL and ≥600 mL, respectively. However, since about 25 percent of menstruant females have absent iron stores, any amount of bleeding will result in anemia in this subpopulation. 

Since availability of iron is normally rate-limiting for RBC production, iron deficiency associated with chronic bleeding leads to a reduced marrow response, worsening the degree of anemia.” 

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