Normal Hemoglobin Values

[Marat]

Healthy males can have a hemoglobin level varyng from 140 up to 180, though there is a gradual decline with age. Most medical textbooks will tell you that an otherwise healthy male patient with a hemoglobin of 130 is anemic and requires some treatment, usually in the form of iron supplements. In supportive cancer therapy, several studies have indicated that increasing patients' hemoglobin levels with erythropoietin either close to or even all the way up to the lower end of the normal range produces important benefits in quality of life. This seems logical, since evolution would not have threatened the survival of the species by creating a demand for calories to support a statistically normal hemoglobin level that was higher than necessary for optimal functioning.

 

However, for some reason in renal medicine it is almost universally assumed that the correction of male patients' hemoglobin levels to the 110-120 range is 'just fine,' and if the patients complain about feeling exhausted all the time, they are simply scolded and told that this is all due to other factors, such as post-dialysis hypotension, the toxic effects of uremia, or just their imagination. The obvious reason for this approach is that in many subclasses of renal patients the correction of anemia with erythropoietin to near-normal levels can cause fistula-clotting, strokes, and heart attacks, so it is all too tempting for nephrologists to convince themselves that the pitiful hemoglobin levels they can safely achieve are adequate.

 

I would recommend, however, that nephrologists take a more careful look at the literature and realize that there are many subclasses of renal patients who can safely tolerate higher levels of hemoglobin, and that even for those who cannot, nephrologists should be prepared to admit that what they can offer is inadequate.