Explain the

interpretation of
hemoglobin result
(low indicator result)
 Low Hemoglobin Levels
 If your hemoglobin level is lower than normal, you have anemia.
 Anemia is then defined by a Hb concentration below an age-, sex-,
or lifestage-specific cutoff. Other factors, such as altitude and
smoking habit, can also influence Hb concentration
 There are many forms of anemia, each with different causes, which
can include

Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O; HEmoglobin MEasurement (HEME)
Working Group. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad
Sci. 2019 Aug;1450(1):126-146. doi: 10.1111/nyas.14003. Epub 2019 Jan 16. PMID: 30652320.
 Iron deficiency. Iron deficiency impairs Hb synthesis and function because iron is an integral
component of Hb. Iron metabolism is tightly controlled to ensure adequate cellular functioning without
causing iron toxicity and iron biomarkers reflect different aspects of this process. (1)

 Vitamin B-12 deficiency. Vitamin B12 is a cofactor for the enzyme methionine synthase, which is used
in the conversion of homocysteine to methionine. As a byproduct of this reaction, methyl-THF is
converted to THF, which is converted to intermediates used in the synthesis of pyrimidine bases of
DNA. In B12 deficiency, homocysteine cannot be converted to methionine, and thus, methyl-THF
cannot be converted to THF. As a result, homocysteine levels accumulate, and pyrimidine bases cannot
be formed, slowing down DNA synthesis and causing megaloblastic anemia. (2)

 Folate deficiency. The deficiency of folate, as a result, leads to impairment of cell division,
accumulation of toxic metabolites, and impartment of methylation reactions required for regulation of
gene expression (4)

 Pregnant woman

 Bleeding
 Cancers that affect the bone marrow, such as leukemia

 Kidney disease. When kidneys are damaged, they produce less erythropoietin (EPO), a hormone that
signals bone marrow to make red blood cells.
 Liver disease. The liver performs a major role in iron homeostasis (3)

 Hypothyroidism. Thyroid hormones stimulate the proliferation of erythrocyte precursors both directly

and via erythropoietin production enhancement (5)

 Thalassemia --> a genetic disorder that causes low levels of hemoglobin and red blood cells
Reference
1. Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O;
HEmoglobin MEasurement (HEME) Working Group. Measurement and interpretation of hemoglobin
concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci. 2019
Aug;1450(1):126-146. doi: 10.1111/nyas.14003. Epub 2019 Jan 16. PMID: 30652320.
2. Ankar A, Kumar A. Vitamin B12 Deficiency. [Updated 2020 Jun 7]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK441923/
3. Gkamprela, E., Deutsch, M., & Pectasides, D. (2017). Iron deficiency anemia in chronic
liver disease: etiopathogenesis, diagnosis and treatment. Annals of gastroenterology, 30(4),
405–413. https://doi.org/10.20524/aog.2017.0152
4. Khan KM, Jialal I. Folic Acid Deficiency. [Updated 2020 Jun 30]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK535377/
5. Szczepanek-Parulska, E., Hernik, A., & Ruchała, M. (2017). Anemia in thyroid
diseases. Polish Archives of Internal Medicine. doi:10.20452/pamw.3985
6. Anemia in chronic kidney disease. (2020, September 01). Retrieved February 14, 2021,
from https://www.niddk.nih.gov/health-information/kidney-disease/anemia