Age [yr]GenderHemoglobin [g/dl]MCV [fl]MeanLower limitMeanLower limit0.5–4M/F12.511.080725–10M/F13.011.5837511–14F13.512.08577M14.012.0857715–19F13.512.08879M15.013.0887920–44F13.512.09080M15.513.59080
Lower limit of normal is 95% range.
From Dallman and Slimes, 19791
Because of the difference in hemoglobin levels, the packed cell volume [PCV] will also be higher in adolescent males than females. However, the mean corpuscular volume [MCV] varies only with age, with average values of 85 fL [lower limit 77 fL] in boys and girls age 11–14, and 88 fL [lower limit 79 fL] in boys and girls age 15–19. The blood volume depends on weight, averaging 75–77 ml/kg in children and adults of both genders.
Bone marrow cellularity and differential cell count are comparable in males and females. However, subtle gender-related differences have been noted, such as the more pronounced age-related decline in alkaline-phosphatase-expressing colony forming units [CFU-AP] seen in women compared to men,2 which could be relevant to gender differences in bone loss and osteoporosis. Recent research on determinants of hematopoietic and mesenchymal stem cell differentiation in healthy subjects and patients with osteoarthritis and rheumatoid arthritis reveals age-related increases in RANKL and PPAR-gamma levels [osteoclast and adipocyte determinants] and DRAK1 expression [apoptosis-related gene] in females but not males.3
Peripheral blood white cell count, platelet count, and coagulation factor levels are all independent of gender, but there may be functional differences. For example, an influence of the menstrual cycle on monocyte cytokine release in response to lipopolysaccharide stimulation has been demonstrated.4 Studies of the immune response to hemorrhagic shock have shown enhanced immune function and lower mortality from subsequent sepsis in females compared to males.5 In a murine model, interleukin-10 treatment restored depressed immune responses [splenocyte proliferation, interferon-gamma, and interleukin 1-β] preferentially in male animals, without further enhancing immune function in female animals, suggesting a potential relative deficit or inhibition of IL-10 in males.
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Red Blood Cell Disorders
Amer Wahed MD, Amitava Dasgupta PhD, DABCC, in Hematology and Coagulation, 2015
3.2 Anemia: Morphological and Etiological Classification
Hemoglobin level is highest at birth, ranging from 16 to 20 g/dL, and then declines, with the lowest hemoglobin level observed at 3–6 months, when values of 9–11 g/dL are considered normal. Men have slightly higher levels of hemoglobin, and this is thought to be due to the stimulatory effect of androgens on the bone marrow. The WHO definitions of hemoglobin less than 12 g/dL in nonpregnant women 15 years of age or older, less than 11 g/dL in pregnant woman, and less than 13 g/dL in men 15 years of age or older are widely used for diagnosis of anemia worldwide. Anemia can be classified on the basis of morphology and etiology. Morphological classification of anemia includes the following:
▪Normocytic normochromic
▪Microcytic hypochromic
▪Macrocytic.
Etiologic classification of anemia includes the following:
▪Anemia due to blood loss
▪Anemia due to deficiency of hematopoietic factors
▪Anemia due to bone marrow failure
▪Anemia due to increased red cell breakdown.
Examples of etiological classification of anemia are listed in Table 3.1.
Table 3.1. Etiological Examples of Anemia
Etiological CauseSpecific ExamplesAnemia due to blood lossGastrointestinal blood loss, menorrhagiaAnemia due to deficiency of hematopoietic factorsIron deficiency, folate deficiency, vitamin B12 deficiency, erythropoietin deficiencyAnemia due to bone marrow failureAplastic anemia, bone marrow infiltration [e.g., metastatic cancer, bone marrow fibrosis], myelodysplasia, bone marrow toxicity [alcohol abuse, chemotherapy]Anemia due to increased red cell breakdownInherited or acquired defects [see Box 3.1]
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Hematologic Manifestations of Malignancy
Page Widick, ... Fred Schiffman, in Hematology [Seventh Edition], 2018
Treatment of Cancer-Related Anemia
Hemoglobin levels typically decrease early in the course of chemotherapy treatment; with greater than half of patients experience a greater than 1 g/dL drop over the course of the first 9 weeks of therapy. The treatment of anemia related to malignancy depends upon correct identification of the underlying etiology. As noted previously, iron-deficiency anemia is very common in patients with malignancy. Among those patients with cancer who have an absolute iron deficiency [transferrin saturation