What is hemoglobin?
Hemoglobin
is the protein molecule in red blood
cells that carries oxygen
from the lungs to the body's tissues and returns carbon dioxide from the
tissues to the lungs.
Hemoglobin
is made up of four protein molecules (globulin chains) that are connected
together. The normal adult hemoglobin (Hbg) molecule contains 2 alpha-globulin
chains and 2 beta-globulin chains. In fetuses and infants, there are only a few
beta chains and the hemoglobin molecule is made up of 2 alpha chains and 2
gamma chains. As the infant grows, the gamma chains are gradually replaced by
beta chains.
Each
globulin chain contains an important central structure called the heme
molecule. Embedded within the heme molecule is iron that transports the oxygen
and carbon dioxide in our blood. The iron contained in hemoglobin is also
responsible for the red color of blood.
Hemoglobin
also plays an important role in maintaining the shape of the red blood cells.
Abnormal hemoglobin structure can, therefore, disrupt the shape of red blood
cells and impede its function and its flow through blood vessels.
How is hemoglobin measured?
Hemoglobin
is usually measured as a part of the complete blood count (CBC) from a blood
sample.
Several
methods exist for measuring hemoglobin, most of which are done currently by
automated machines designed to perform several different tests on blood. Within
the machine, the red blood cells are broken down to get the hemoglobin into a
solution. The free hemoglobin is exposed to a chemical containing cyanide which
binds tightly with the hemoglobin molecule to form cyanmethemoglobin. By
shining a light through the solution and measuring how much light is absorbed
(specifically at a wavelength of 540 nanometers), the amount of hemoglobin can
be determined.
What are normal hemoglobin values?
The
hemoglobin level is expressed as the amount of hemoglobin in grams (gm) per
deciliter (dl) of whole blood, a deciliter being 100 milliliters.
The
normal ranges for hemoglobin depend on the age and, beginning in adolescence,
the gender of the person. The normal ranges are:
- Newborns: 17-22 gm/dl
- One (1) week of age: 15-20 gm/dl
- One (1) month of age: 11-15gm/dl
- Children: 11-13 gm/dl
- Adult males: 14-18 gm/dl
- Adult women: 12-16 gm/dl
- Men after middle age: 12.4-14.9 gm/dl
- Women after middle age: 11.7-13.8 gm/dl
All
of these values may vary slightly between laboratories. Some laboratories do
not differentiate between adult and "after middle age" hemoglobin
values.
What does a low hemoglobin level mean?
A
low hemoglobin is referred to as anemia.
There are many reasons for anemia.
Some
of the more common causes are:
- loss of blood (traumatic injury, surgery, bleeding colon cancer or stomach ulcer),
- nutritional deficiency (iron, vitamin B12, folate),
- bone marrow problems (replacement of bone marrow by cancer,
- suppression by chemotherapy drugs,
- kidney failure), and
- abnormal hemoglobin (sickle cell anemia).
What does a high hemoglobin level mean?
Higher
than normal hemoglobin levels can be seen in people living at high altitudes
and in people who smoker. Dehydration produces a falsely high hemoglobin which
disappears when proper fluid balance is restored.
Some
other infrequent causes are:
- advanced lung disease (for example, emphysema),
- certain tumors,
- a disorder of the bone marrow known as polycythemia rubra vera, and
- abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes.
What is sickle cell disease?
Sickle
cell disease is a genetic condition in which the quality of hemoglobin is
defective. This condition can cause abnormal hemoglobin which, in turn, can
result in abnormally shaped (sickled) red blood cells. These abnormal red blood
cells cannot easily pass through small blood vessels and, therefore, could
deprive the body organs of adequate oxygen.
Sickle
cells also have a shorter life span than normal red blood cells (10-20 days
compared to 120 days). This rapid turn over may result in inadequate time to
replace the red blood cells and may result in anemia.
In
order for a person to have sickle cell anemia, one defective hemoglobin gene
must be inherited from each parent. If only one gene is inherited from one
parent, then the conditions is much milder and it is referred to as sickle cell
trait.
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