I’m continued to be baffled by consistently low RBC and hermatocrit over the last few years. I’ve been testing around 4.3 RBC and 41-42 hermatocrit, and my MCV and MCH have been a little high - 95-96 and 32-33. Ferritin levels have been stable at around 70-80, iron tested slightly high (162), transferrin was 195 (lowish), percent saturation 58% (high). Testosterone is also fine - high side of normal.
I have an established baseline hermatocrit in the upper 40s prior to the last 2-3 years. I would test 47-48 typically and even had a 51 once when I was living at 6300 ft altitude (I’ve been living at sea level for the last 15 years). 42 year old male, training about 10-12 hours a week on my heavy weeks.
I thought maybe B12 was involved but I started getting weekly injections 3 months ago to rule that out and it has not affected my numbers nor improved my performance/energy levels. I eat very healthy - whole grains, legumes, lots of leafy greens - and take an endurance athlete specific multi-v as well as additional iron. I have not tested folate but would be surprised if it’s low, given my diet and supplementation.
My family practice doesn’t listen to my concerns - they think everything is fine. But given my history of high hermatocrit I can’t help but think there’s something going on to explain this drop the last 2-3 years. What kind of specialist would be best to help figure out what’s going on?
Training-related increased blood plasma volume will keep your Hct seeming low when it’s fine.
If you sweat a lot in training, particularly in high heat areas, your body will learn to hold more plasma (liquid portion of your blood) so it’s ready to keep you hydrated when you start your typical sweatfest.
If you decondition from now, I’ll bet your Hct goes back to normal since your body will learn to no longer retain all that plasma.
I was 47-51 Hct prior to the last 2-3 years and I was training overall harder and longer during those times. And yes I was also sweating quite a lot. So I don’t find that explanation compelling.
I’m continued to be baffled by consistently low RBC and hermatocrit over the last few years.** I’ve been testing around 4.3 RBC and 41-42 hermatocrit, **…?
Nothing is going on, your levels are perfectly normal.
Normal range for HCT is .38 - .50
Normal range for RBC is 4.0 - 5.5
Everyone is different, and your levels can fluctuate, even day to day for various reasons. I often test -slightly- below the normal levels, but have also tested mid-range at times… I mentioned it once to my PCP (who knows her shit) and she laughed at the fact that I knew what HCT was, and congratulated me on having somewhat thin blood, that I was less likely to stroke out.
I was 47-51 Hct prior to the last 2-3 years and I was training overall harder and longer during those times. And yes I was also sweating quite a lot. So I don’t find that explanation compelling.
Not sure if this is what was going on, but just to be clear, if you are dehydrated, your HCT and RBC numbers will be -elevated-.
“Both the hemoglobin and the hematocrit are based on whole blood and are therefore dependent on plasma volume. If a patient is severely dehydrated, the hemoglobin and hematocrit will appear higher than if the patient were normovolemic; if the patient is fluid overloaded, they will be lower than their actual level.”
I’m continued to be baffled by consistently low RBC and hermatocrit over the last few years. I’ve been testing around 4.3 RBC and 41-42 hermatocrit, and my MCV and MCH have been a little high - 95-96 and 32-33. Ferritin levels have been stable at around 70-80, iron tested slightly high (162), transferrin was 195 (lowish), percent saturation 58% (high). Testosterone is also fine - high side of normal.
I have an established baseline hermatocrit in the upper 40s prior to the last 2-3 years. I would test 47-48 typically and even had a 51 once when I was living at 6300 ft altitude (I’ve been living at sea level for the last 15 years). 42 year old male, training about 10-12 hours a week on my heavy weeks.
I thought maybe B12 was involved but I started getting weekly injections 3 months ago to rule that out and it has not affected my numbers nor improved my performance/energy levels. I eat very healthy - whole grains, legumes, lots of leafy greens - and take an endurance athlete specific multi-v as well as additional iron. I have not tested folate but would be surprised if it’s low, given my diet and supplementation.
My family practice doesn’t listen to my concerns - they think everything is fine. But given my history of high hermatocrit I can’t help but think there’s something going on to explain this drop the last 2-3 years. What kind of specialist would be best to help figure out what’s going on?
Disclaimer: MD here
I struggle to see that there is anything going on or any actual issue.
If you have decreased your training load there are a number of reasons why your haematocrit would drop as well. Haematocrit is basically the proportion of your red cells to plasma volume. Train hard, train at altitude etc and you will expect a rise in your red cells relative to your plasma volume and therefore see a higher haemotocrit. If you are backing off your training etc then it is normal to see this fall into the more normal parts of the reference range.
Do you know what your haemoglobin is doing?
Your iron is a little on the low side. Ferritin of <100 is slightly less than optimal in a male, <30 is diagnostic of iron deficiency so you are a fair way from that but you would be wise to look at your iron intake.
In terms of who to see to look into this, well, part of me agrees with your family practice, there is not really anything to see here. But, a good sports specialist or a haematologist are good people to see.
I was 47-51 Hct prior to the last 2-3 years and I was training overall harder and longer during those times. And yes I was also sweating quite a lot. So I don’t find that explanation compelling.
So you decreased training volume and intensity? That alone explains the decrease in HCT.
The 51 is probably an outlier, with some effect of altitude. For what it’s worth the UCI upper limit is 50.
Mine is mostly around 46 or 47, my son’s was once 50. The range in a bloodtest given for “normal value” goes over 50, I remember 52 or so. Which is what I never understood: if the normal, natural range proposed by medical science goes over 50, why is the UCI limit already at 50.
How and why do you know all these markers? If you’re in the normal range then what’s the reason for querying it? .
He knows because he gets regular blood work done, apparently. Not unusual.
If you’re in the normal range then what’s the reason for querying it? .
He stated pretty clearly he’s wondering why it dropped from what he was used to seeing. But yes, as you just said, its still normal and various reasons mentioned explain it.
I had same issues as OP and a triggered my doctor to send me to a hematologist. That appointment lasted all of 15-minutes. Although my numbers were much lower than average, I’m still within a ‘healthy’ range.
I am anemic and he did put me on 60mg of iron daily. Being a male, they shy away from iron supplements, thus I had to get my blood drawn every 3-months for the first year to watch my iron levels. My iron levels slowly rebounded. Even taking 60mg, I only maintained an ‘average’ level (in blood iron tests). Still, that small increase did improve my overall feeling and performance.
They called my anemia, ‘endurance induced anemia’.
I was 47-51 Hct prior to the last 2-3 years and I was training overall harder and longer during those times. And yes I was also sweating quite a lot. So I don’t find that explanation compelling.
So you decreased training volume and intensity? That alone explains the decrease in HCT.
No, I think the opposite happens.
Decreased fitness usually leads to elevation of hematocrit. This is caused by reduction in plasma volume.
Increased fitness usually leads to decreased hematocrit. This is caused by increases in plasma volume.
Living at altitude usually increases hematocrit. This is caused acutely by dehydration (diuresis). It is caused more chronically by increased RBCs.
Living at sea level, coming down from altitude, usually decreases hematocrit. This is caused chronically by slow loss of RBCs. I’m unaware of any increases in acute hydration status caused by reduced diuresis, only because I haven’t looked into it.
Slight elevation in markers of increased RBC formation is normal in endurance athletes, especially those who run. Hemolysis (RBC breakdown) means that the body needs more RBCs to be made.
To OP, was there a trend downwards in your hematocrict when it was 47-51?
While you are training less now, how is your fitness, compared to back then? Chronic training, even if reduced towards the end of a long period of training, can continue to reduce hematocrit due to plasma volume expansion.
I don’t think there is anything noteworthy going on here.
I’m not an MD. Chat with your physician. ↠Liability coverage statement.
