What does a hemoglobin of 10.4 g/dL and a hematocrit of 34.6% indicate?

Interpretation of Hemoglobin 10.4 g/dL and Hematocrit 34.6%

A hemoglobin of 10.4 g/dL and hematocrit of 34.6% indicates mild anemia that falls below the normal reference range but is within the target range recommended for patients with chronic kidney disease. 1

Normal Reference Ranges

• Normal hemoglobin values vary by age and gender:
  • Adult males/post-menopausal females: 15.5 ± 2.0 g/dL (Hct 47 ± 6%) 1
  • Menstruating females: 14.0 ± 2.0 g/dL (Hct 41 ± 5%) 1
  • Children have age-specific ranges that gradually increase with age 1

Clinical Significance of These Values

• The values of Hb 10.4 g/dL and Hct 34.6% fall within the target range (Hb 11-12 g/dL, Hct 33-36%) recommended for patients with chronic kidney disease on Epoetin therapy 2
• These values are below the WHO definition of anemia (Hb <12.0 g/dL in women and <13.0 g/dL in men) 3
• The values suggest mild anemia, as they are above the more restrictive transfusion threshold of 7-8 g/dL (Hct 20-24%) used in hospitalized patients 4

Potential Causes to Consider

• Chronic kidney disease (CKD) - these values align with target ranges for CKD patients 2
• Iron deficiency - the most common cause of anemia worldwide 5, 3
• Cancer-related anemia - values are consistent with mild cancer-related anemia 2
• Myelodysplastic syndrome - particularly in older patients 2
• Chronic disease/inflammation - accounts for approximately one-third of anemia cases in elderly patients 3
• Blood loss - acute or chronic 2
• Nutritional deficiencies (folate, vitamin B12) 3

Important Diagnostic Considerations

• These values alone are insufficient for a definitive diagnosis - additional testing is required 5
• A complete blood count with red cell indices should be evaluated 2
• Iron studies are essential (serum ferritin, transferrin saturation) as normal Hb/Hct can mask iron depletion 5
• Reticulocyte count should be measured to assess bone marrow response 2
• Vitamin B12 and folate levels should be checked 2
• Inflammatory markers may be helpful (CRP, ESR) 3

Clinical Implications

• For CKD patients, these values fall within the target range (Hb 11-12 g/dL, Hct 33-36%) and may not require intervention 2
• Values below Hb 11 g/dL (Hct 33%) in CKD patients are associated with increased morbidity and mortality 2
• Quality of life improvements are seen when Hb/Hct is maintained between 11-12 g/dL (33-36%) in CKD patients 2
• In patients with heart disease, targeting normal Hct levels (42%) may increase risk of adverse events 2
• For surgical patients over age 40, levels below Hb 10 g/dL (Hct 30%) may increase risk, particularly with silent myocardial ischemia 6

Next Steps

• Determine if the patient has known CKD, as these values may be appropriate targets 2
• Evaluate for symptoms of anemia (fatigue, weakness, dyspnea on exertion) 2
• Complete iron studies (ferritin, TSAT) to rule out iron deficiency 2, 5
• Consider the rate of Hb/Hct decline by comparing to previous values 2
• Assess for underlying conditions that could cause anemia 3
• If the patient has CKD and is on ESA therapy, these values may be within target range and require no adjustment 2