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Hemogram (Blood Count)


The hemogram is a blood count.  It gives us data on the number and size of red blood cells and indicators on the amount of hemoglobin present in the blood.  Blood counts give more than numbers in that they can suggest  a deficiency in specific nutrients by what they show.  Iron deficiency typically results in fewer red blood cells (RBCs) being produced and those will tend to be smaller than normal and contain less hemoglobin.  A vitamin B12 deficiency will typically present differently, with larger red blood cells, and bulky less efficient hemoglobin content. Combined with an assessment of the nutrient levels of those that can cause anemia, excellent information can be obtained about how one's nutritional status might be hampering optimal oxygen transport and henceforth, performance and endurance. 

Some of the measurements from a Hemogram:

Hemoglobin(Hb) = iron containing blood protein which transports oxygen= indicator of anemia or pseudo anemia. Optimum Range: 12-15 g/dL females,  14-17g/dL males


Most of the body’s iron (about 60%) is contained in hemoglobin, which is the essential oxygen carrying protein of the blood. Hemoglobin carries oxygen to your body's organs and tissues and transports carbon dioxide back to your lungs. Anemia simply refers to a low hemoglobin level.  This typically indicates a low red blood cell count and a hampered ability to move oxygen to the muscles and organs of the body.  This, as you can imagine, is not a condition favorable to any athlete.  The most common cause of anemia is iron deficiency.   Your body requires iron to make hemoglobin.  If it is amply available in stores of iron (ferritin) it will source it there.  If iron stores are low, hemoglobin levels drop and oxygen transport suffers.  When iron levels are low and hemoglobin is also low, this is termed iron deficiency anemia.  This anemia can lead to significant decreases in athletic performance, work capacity and reduced VO2max  It is possible to have low iron stores but still normal hemoglobin levels.  This condition, sometimes referred to as iron deficient non anemic, is not as serious as iron deficiency anemia but can still lead to fatigue, reduced productivity, and ultimately to reduced endurance and poor recovery from training. Recent research confirms this.

The reliability of Hemoglobin levels as a standalone indicator of anemia in endurance athletes is complex however.  Sports anemia or dilutional pseudo-anemia is one of the body's adaptive strategies to the stress of significant exercise and exertion.  It is not a true anemia but rather a normal response to exercise,  yet it does cloud our picture a bit when trying to assess an athlete's nutrient and lab marker status.  

With intense exercise, the body quickly adapts and increases water and salt retention. This can increase plasma volume by as much as 10%  quite quickly after beginning training, and can therefore skew hemoglobin concentration lab results down, creating the impression of anemia.  Greater plasma volume with the same number of red blood cells will read like an anemia.  It has been shown, however, that as the plasma volume increases, so too does cardiac stroke volume, to a degree that more, not less, oxygen is delivered to muscle.  After a few months of consistent training blood concentrations typically normalize, though some athletes can maintain the sports anemia through consistent training.  

As well, for athletes living and training at altitude, we would expect their hemoglobin concentration and hematocrit to be generally higher than those training closer to sea level  due to the body's adaptive strategy to lower concentrations of oxygen at elevation.  It is because of these complexities and variabilities that RunTheLabs panels include an assessment of the related nutrients along with the blood count, and recommends follow up testing at several month intervals.   



Hematocrit (HCT) = percentage of RBCs of total blood =indicator of anemia or pseudo anemia  Optimum Range: 13-18years: females-34.0-46.0% males-36.0-49.0%.      19years plus:  females-35.0-45.0% males-38.5-50.05%


Most blood is made up of red blood cells (RBC) and plasma.  A hematocrit is the percentage of whole red blood cells, by volume,  in your blood.  It is another marker, in addition to hemoglobin concentration,  used to assess for anemia.  As discussed with regards to hemoglobin concentration, a training athlete's body can respond to the training stress by increasing plasma volume in order to lend greater cardiac output and efficiency.  Red blood cell numbers also increase as a result of training, however they don't always increase in total volume to keep pace with with the increased plasma volume and we see decreases in hematocrit values.  This again represents the phenomena of sports anemia or dilutional pseudo anemia. Therefore, as with hemoglobin concentration, hematocrit numbers in a trained athlete are variable and not very reliable indicators, by themselves, of a true anemia or a compromised ability to transport oxygen.  Sports anemia responses to training renders hemoglobin and hematocrit markers, ones that we typically value in conjunction with nutrient biomarker levels  as opposed to markers we rely upon as stand alone tests.  We value trends in both hemoglobin and hematocrit during dietary amendment periods to correct for key nutrient deficiencies known to potentiate lowered hemoglobin and red blood cell counts in the body. If, for instance, dietary changes or supplementation were employed due to initial suboptimal nutrient level lab results and we see improvement in hemoglobin and/or hematocrit values corresponding to improvement in the status of that nutrient, we would presume that the nutrient inadequacy had been hampering oxygen transport and hence likely performance.  In this example, the lower initial hematocrit and hemoglobin levels were likely not entirely explained by the sports anemia phenomena for such response to occur.  It is difficult and unnecessary to target an optimum range for such values.  RunTheLabs' philosophy holds that athletes, coaches and trainers should focus on optimizing nutrient levels in the body, that the physiological process that is homeostasis (self balancing) will take care to optimize these other markers and the result is improved safety of training, performance and recovery.    


MCV = Mean Corpuscular Volume = indicates size or volume of red blood cells         


MCV is actually a measure of the average volume of red blood cells, also known as erythrocytes or corpuscles, per a given volume of blood.  From this, the average size of a red blood cell in the individual can be inferred. This measure is commonly performed as part of a complete blood count or CBC.  For our purposes of athletic performance nutritional analysis, we pull it out of the CBC and run it along with serum homocysteine, as it can give an indication of anemia as well as causation of anemia.  Low MCV is indicative of microcytic anemia or an anemia with smaller than normal red blood cells, most commonly caused by iron deficiency. Elevated MCV is indicative of macrocytic or megaloblastic anemia, with larger than normal red blood cells,  and hence implicates deficiencies of B6, folate, and/or B12. An elevated MCV, along with elevated serum homocysteine and/or issues with serum B12, serum MMA or serum folate may again, also point to a hereditary methylation issue that can be further tested by looking for mutations of MTHFR.