Where Do They Get Those Numbers For Blood Tests?


“Ten” (10) is an easy number to remember.

I have no doubt, although many years have passed, that 10 grams per decileter was the laboratory value at which I had to prescribe a blood transfusion for everybody.

I even remember what the Chief of surgery said (when I was doing my internship in surgery) in a very gentle and civilized hospital in the midwest.

“I won’t forgive you if you wake me up in the middle of the night for this one.  I’ll wake you up in the middle of the night when you don’t expect it some night if I have to.”

“People need blood.  People lose blood when they have surgery.  Anyone under 10, just transfuse.”

So it is a personal friend, who is physically dragging turns out to need an operation for an abscess.  She told me, a few days before, her Hemoglobin was 10.

They did the surgery and — guess what — she was even more exhausted and draggy after the operation.

Her surgeon had told her that NOBODY would transfuse a surgical candidate until their hemoglobin was down to 7 (“seven!”) grams per deciliter.

This guideline somehow had changed when I wasn’t looking.

My head became full of questions.  Why had it changed?  Why were people transfusing less?  Had this caused any deaths, or illnesses, or changed the way people recovered from surgery?

Like a trained psychiatrist always asks, what was the agenda?

Here is the most recent issue of the American Red Cross Guide to Transfusions.

Here is a list of international guidelines:

I have looked at a few of these; they are remarkably consistent, and seem to be based on “meta-analysis.”  This is a technique by which the results of research studies are combined statistically, analyzed for the quality of the evidence, the experimental design, the numbers of research subjects, etc.

I remember when this trend started in academic medical research.  I felt as if I were stuck in a track of nickel-and-dime schools that would never have enough budget to do studies this big.

The number “7” is remarkably consistent as the number hemoglobin can descend to before considering transfusion, at least of red blood cells.

There is a more general review of how loss of blood has affected the human organism.  Perhaps more clinically than in blood test numbers.  Quality and frequency of heartbeat and respiration, for example, play a significant part in making this kind of decision.  And LOTS of blood products, like fresh-frozen plasma, or platelets, have different indications.

There are an overwhelming amount of tables for everything.  From an overview it looks like there is no deliberate attempt to use less blood.  There is a step, which, determines “compatibility, which does things like screening for the tracks left by all sorts of illness that might be transmitted via transfusion.

This is too enormous a problem for me to do any kind of comprehensive review here.

Blood can’t be manufactured, is in dire need, is most often donated for simple humanitarian reasons, and the need for donors seems to be permanently in advance.  If altruism springs eternally within, this a great thing to do in order to promote the survival of humans.

It is also worthwhile to know something about what a human can do if they have a low number of red blood cells and/or a low hemoglobin and/or hemacocrit.

Mayo clinic covers the basics here:

Normal measures for hemoglobin are 13.5 to 1.7 grams per deciliter for men and 12.0 to 15.5 grams per deciliter..

A quick list of illnesses that may cause these values to be lower than normal includes (but may not be limited to:
* Some deficiencies including Iron, vitamin B12, and folate.
* Bleeding of any cause, cancer (especially leukemia),
* Kidney and liver disease, low thyroid,
* Thalassemia, a genetic disease of Hemoglobin.

You can increase hemoglobin by following these guidelines:
Eat foods rich in iron; my faves are beef and seafood, broccoli and spinach.
Eat foods rich in folic acid.  My faves include avocados, black-eyed peas, and the ever popular beef and spinach.
Calcium can diminish the body’s absorption of iron, but you still need some.  A lot of docs say “just get prenatal vitamins and take them for a few months” and sometimes this is enough.  Sometimes more vitamins are necessary and helpful; higher amounts of B and C.

Another good source on this:

Problems like a fast pulse, fatigue, bruising, headaches, pale gums: anything in this ball park, see a doctor.  Please.
You can look up anything you want on the internet, but there is no substitute for someone who has turfed the problem before and knows what to do with it.

Check doctors by reviews, recommendations —  whatever you can.  Do not expect insurance companies to jump to your aid. I have had skirmishes with them a lot lately.  If possible, try to find a doctor who has had the problem themselves, or someone who has had similar problems in their family.

When push comes to shove, if you feel in your guts something is wrong and there is no help, pay for a second opinion.  Health really is priceless.

I have learned through some common illnesses — mainly by surviving them — and taking care of myself.

Remember, if a doctor tells you that your problem is common with aging folks, find an older doctor.

I think they still say it in the US Army, as they did in my day, “Never give up; never surrender.”

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