For women who are not pregnant, the normal hemoglobin range is The normal ranges for both men and women may vary somewhat from one laboratory to another and also vary according to altitude. At higher altitudes, the body produces more red blood cells in response to the decreased oxygen available. A higher number of red blood cells means that hemoglobin levels and hematocrit are also increased. Test results below the low end of the normal range for either hemoglobin or hematocrit can indicate anemia.
If initial tests show anemia, more blood tests may be done to establish the cause of the anemia and the best approach to treatment. For example, a test for the level of iron in the blood is often done, since iron deficiency is the most common cause of anemia. Other diagnostic tools include a physical examination and asking about such things as family history of anemia, diet, use of prescription or over-the-counter drugs, heavy menstrual bleeding in premenopausal women , and any signs of internal bleeding, such as blood in stools.
As a side note, blood glucose meters have a hematocrit range at which they give accurate results. The package insert that came with your meter should state its hematocrit range.
Treatment and prevention The treatment for anemia depends on the cause and severity of it. For other causes or more serious cases, other steps may need to be taken, such as treating an underlying disease, taking vitamin or mineral supplements, and making dietary changes.
In all cases, it takes time for the body to create new, healthy red blood cells, so a person is likely to feel better gradually. Because anemia can recur, depending on the cause, the steps taken to treat it may need to be continued — possibly for life — to prevent it from coming back. If you have kidney problems, you should be under the care of a nephrologist, a physician who specializes in kidney diseases.
Treatment for anemia related to kidney disease may include both steps to reverse the anemia and steps to improve kidney function or prevent it from worsening. For example, to reverse the anemia, injections of a type of drug called an erythropoiesis-stimulating agent may be prescribed to stimulate your bone marrow to produce red blood cells. In addition, drug therapy with certain types of blood pressure drugs may be prescribed to prevent further kidney damage. If your kidney damage is already severe, however, you may need dialysis or a kidney transplant.
No matter how severe your kidney disease, you should meet with a registered dietitian who specializes in kidney diseases to help you with your food choices.
People with diabetes and kidney disease have dietary needs that are somewhat different from those of people who have diabetes and no kidney disease. In particular, they need individualized guidelines for protein, potassium, phosphorus, and fluid intake, as well as for carbohydrate intake.
Take your medicines as prescribed, and follow your healthy lifestyle plan. Following the recommendations of WHO to use HbA1c as the diagnostic method for T2D, the UK via its government's Department of Health issued expert guidance stating that one of the major issues affecting this technique was anemia, which affects the levels of haemoglobin Hb in the blood. The review of research between and included studies which had at least one measurement of HbA1c and glucose, and at least one index of anemia involving non-pregnant adults not diagnosed with diabetes.
The authors identified 12 studies suitable for inclusion, the majority of which focused on iron deficiency anemia and, in general, demonstrated that the presence of iron deficiency with or without anemia led to an increase in HbA1c values compared with controls, with no corresponding rise in blood glucose, thus rendering any diagnosis of diabetes in such individuals unreliable without further tests.
The authors say: "HbA1c is likely to be affected by iron deficiency and iron deficiency anemia with a spurious increase in HbA1c values. This may lead to confusion when diagnosing diabetes using HbA1c. This review clearly identifies the need for more evidence, especially in identifying the types and degrees of anemia likely to have significant impact on the reliability of HbA1c. While further evidence is gathered, the authors make several recommendations regarding clinical practice, including:.
Calling for more research in view of the relatively small number of studies they were able to include in their review, the authors conclude: "The key questions that are still to be answered are whether anemia and red blood cell abnormalities will have a significant impact on the diagnosis of diabetes using HbA1c in the general population--something that is now widely performed. Materials provided by Diabetologia. The importance of identifying and treating anemia cannot be overestimated.
Pernicious anemia can be dangerous because it can strain the heart and blood vessels especially hard. One study found that patients with Type 1 diabetes and anemia were twice as likely to develop a macrovascular disease as those without anemia. Happily, B12 injections are very effective treatment. Anemia is much more common with type 2 diabetes because of the increased body mass index and poor diet choices. Those with type 2 diabetes and anemia should intend to lower their risk by controlling their blood sugar.
They should also eat healthy and exercise to prevent obesity and high blood pressure. Many foods that are high in iron are high in fat, such as red meat. These foods should be eaten in moderation and foods with lower fat content should be selected. If you are unsure about which foods are best, talk to a dietician.
Anemia is common during pregnancy. Iron deficiency can lead to problems with the baby such as a low birth weight and possibly needing a blood transfusion at birth. It can also cause post-partum depression for the mother. Having a folate folic acid deficit can lead to a low-birth weight or spine and brain defects. Almost all pregnant women are advised to eat foods high in iron and folate, and prescribed prenatal vitamins high in both.
Women with gestational diabetes and anemia should eat foods high in folic acid and iron like those listed above. They should also have adequate Vitamin C intake, because that helps iron absorption.
You need a good diet, a disciplined approach, and qualified medical help:. Indirectly, yes: the complications that diabetes cause like kidney disease make anemia more likely. Taking care of yourself and controlling your diabetes is the most important thing to do to decrease your risk.
Anemia can make your complications from diabetes worse. It can worsen eye disease, kidney problems, heart disease, and make diabetic ulcers harder to heal. It also decreases the quality of life because of the lack of energy. All participants signed the informed consent in this research. The sample size was calculated by StatCalc application EpiInfo 3. The study excluded those patients who had difficulties to understand the proposed procedures, those who were bedridden, and those who had difficulty walking.
The invitation to participate in the study was made to patients during home visits, with the monitoring of community health workers when possible. The interviews and tests were conducted by trained health professionals. Data collection was performed by applying a semistructured instrument. The presence of anemia was considered as the dependent variable; the patient was considered anemic, according to the World Health Organization reference values [ 17 ].
Every patient who declared himself a smoker at the moment of evaluation is considered smoker, regardless of the amount of cigarettes consumed; and alcoholic is the person who reported excessive consumption of alcohol during the study period, at any frequency. Excessive salt intake was measured by the question: Do you put much salt in your food? Stress was assessed by the question: Do you consider yourself a stressed person? There were classified physically inactive patients who reported not performing any type of regular exercise with the lowest frequency of three times a week.
At the end of the clinical evaluation, an appointment was made with the date and the time of collection of blood from each patient. Patients personally received clarification on the procedures of collection and were instructed to fast for at least eight hours prior to the blood collection, in addition to writing instructions and containers for the collection of the first urine in the morning.
Among the laboratory tests that were performed are the creatinine dosage and blood glucose by enzymatic Trinder method [ 20 ]. In addition, the collection and enforcement of the blood count were performed to evaluate the presence of hematological disorders in patients with DM2.
The blood sample, was also used the serum of patients after venipuncture and centrifugation of whole blood for biochemical measurements, as well as whole blood anticoagulant containing standard for hematologic examinations. Renal function was assessed by the value of serum creatinine, obtained by biochemical tests.
The glomerular filtration rate is estimated by the Cockcroft-Gault calculated using the formula available on the websites of the Brazilian Society of Nephrology SBN of the National Kidney Foundation [ 22 ]. For the use of the Cockcroft-Gault equation, the ideal weight of the patient was computed using the Lorenz formula, which puts the ideal body weight for the subjects height in cm function [ 26 ].
In the statistical analysis, all variables were tested for normality using the Kolmogorov-Smirnov KS test. The Spearman correlation coefficient was used to evaluate the correlation between clinical and biochemical parameters with the hemoglobin level. These data are presented in Table 1. The same is observed with respect to glucose, however, with higher values in the group without anemia. These data are presented in Table 2. Table 3 shows the correlations between the clinical and biochemical parameters with hemoglobin.
It is observed that there are positive and weak correlation between glucose and hemoglobin and negative and weak correlation between BMI and hemoglobin. Often, chronic diseases, such as DM, are accompanied by mild-to-moderate anemia, often called anemia of inflammation or infection or anemia of chronic disease [ 27 ]. Andrews and Arredondo [ 28 ] determined the presence of anemia in type 2 diabetic patients as well as evaluating the expression of genes related to inflammation and immune response.
The results found by the authors demonstrate that diabetic patients with anemia exhibit increased expression of proinflammatory cytokines as compared to diabetic patients only.
In anemic patient increase in IL-6 production, as well as B cell activity, was confirmed which reinforces the association between IL-6 and antierythropoietic action.
Moreover, the diabetic and anemic patients had high levels of C-reactive protein and ferritin ultrasensible; however, these diabetic and anemic patients had low iron contents, showing that ferritin increases were associated with chronic inflammatory process present in diabetes [ 28 ].
In this study, there was a higher prevalence of obesity and higher mean BMI and waist circumference in anemic patients when compared to nonanemic ones; however, there was a statistically significant difference between the groups only for body mass variable.
Anemia in diabetic patients is also related to obesity, BMI, and high waist circumference. The obesity or accumulation of circulating fatty acids is associated with the development of an inflammatory state that predisposes the development of insulin resistance. Insulin resistance reduces glucose tolerance especially in adipocytes and muscle cells, in which glucose uptake is insulin. This causes glucose accumulation in the circulation and consequently a hyperglycemic state [ 29 ].
Adipose tissue has more recently been recognized as a metabolically active organ system linking the endocrine and immune systems; furthermore it is the source of a variety of cytokines. Higher baseline BMI remained a predictor of additional adjustments for blood pressure level and the presence or absence of diabetes mellitus.
Similar to TNF-alpha, IL-6 is a proinflammatory adipokine that correlates with body weight and insulin resistance [ 30 ]. The increased inflammatory activity in adipose tissue of obese patients favors the production of hepcidin that in anemia of chronic disease is increased during infection and inflammation, causing a decrease in serum iron level through a mechanism that limits the availability of iron.
The association of higher iron stores with diabetes and insulin resistance has been repeatedly confirmed by many investigators. Ferritin levels were found to predict a higher rate of diabetes in prospective studies and case-control cohorts. Furthermore, serum ferritin was positively associated with body mass index BMI , visceral fat mass, serum glucose levels, insulin sensitivity, and cholesterol levels [ 31 — 33 ]. In addition, it was found in this study that the prevalence of hypertension in diabetic patients that were anemic was significantly higher when compared to nonanemic ones.
This association is of concern considering that hypertension in diabetic increases the risk of cardiovascular complications such as heart failure, stroke, tissue inflammation, and atherosclerosis [ 4 ].
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