Hematocrit

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Hematocrit

Blood components
MeSH D006400
MedlinePlus 003646

The hematocrit (/hɪˈmætəkrɪt/) (Ht or HCT), also known by several other names, is the
volume percentage (vol%) of red blood cells (RBC) in blood, measured as part of a
blood test.[1] The measurement depends on the number and size of red blood cells.[2] It is
normally 40.7%–50.3% for men and 36.1%–44.3% for women.[3] It is a part of a
person's complete blood count results,[4] along with hemoglobin concentration, white
blood cell count and platelet count.

Because the purpose of red blood cells is to transfer oxygen from the lungs to body
tissues, a blood sample's hematocrit—the red blood cell volume percentage—can
become a point of reference of its capability of delivering oxygen. Hematocrit levels
that are too high or too low can indicate a blood disorder, dehydration, or other medical
conditions.[5] An abnormally low hematocrit may suggest anemia, a decrease in the total
amount of red blood cells, while an abnormally high hematocrit is called polycythemia.
[6]
Both are potentially life-threatening disorders.

Contents
 1 Names
 2 Measurement methods
 3 Levels
 4 Shear rate relations
o 4.1 Elevated
o 4.2 Lowered
  5 See also
 6 References
 7 External links

Names
There are other names for the hematocrit, such as packed cell volume (PCV), volume of
packed red cells (VPRC), or erythrocyte volume fraction (EVF). The term hematocrit
(or haematocrit in British English) comes from the Ancient Greek words haima (αἷμα,
"blood") and kritēs (κριτής, "judge"), and hematocrit means "to separate blood".[7][8] It
was coined in 1891 by Swedish physiologist Magnus Blix as haematokrit,[9][10][11]
modeled after lactokrit.

Measurement methods

Diagram of packed cell volume

With modern lab equipment, the hematocrit can be calculated by an automated analyzer
or directly measured, depending on the analyzer manufacturer. Calculated hematocrit is
determined by multiplying the red cell count by the mean cell volume. The hematocrit is
slightly more accurate, as the PCV includes small amounts of blood plasma trapped
between the red cells. An estimated hematocrit as a percentage may be derived by
tripling the hemoglobin concentration in g/dL and dropping the units.[12].

The packed cell volume (PCV) can be determined by centrifuging EDTA-treated or

heparinized blood in a capillary tube (also known as a microhematocrit tube) at
10,000 RPM for five minutes.[13] This separates the blood into layers. The volume of
packed red blood cells divided by the total volume of the blood sample gives the PCV.
Since a tube is used, this can be calculated by measuring the lengths of the layers.[citation
needed]

Another way of measuring hematocrit levels is by optical methods such as

spectrophotometry.[14] Through differential spectrophotometry, the differences in optical
densities of a blood sample flowing through small-bore glass tubes at isosbestic
wavelengths for deoxyhemoglobin and oxyhemoglobin and the product of the luminal
diameter and hematocrit create a linear relationship that is used to measure hematocrit
levels.[15]

There are some risks and side effects that accompany the tests of hematocrit because
blood is being extracted from subjects. Subjects may experience a more than normal
amount of hemorrhaging, hematoma, fainting, and possibly infection.[16]

While known hematocrit levels are used in detecting conditions, it may fail at times due
to hematocrit being the measure of concentration of red blood cells through volume in a
blood sample. It does not account for the mass of the red blood cells, and thus the
changes in mass can alter a hematocrit level or go undetected while affecting a subject's
condition.[17] Additionally, there have been cases in which the blood for testing was
inadvertently drawn proximal to an intravenous line that was infusing packed red cells
or fluids. In these situations, the hemoglobin level in the blood sample will not be the
true level for the patient because the sample will contain a large amount of the infused
material rather than what is diluted into the circulating whole blood. That is, if packed
red cells are being supplied, the sample will contain a large amount of those cells and
the hematocrit will be artificially very high.

Levels
External image

RBC volume

Hematocrit can vary from the determining factors of the number of red blood cells.
These factors can be from the age and sex of the subject.[clarification needed][18] Typically, a
higher hematocrit level signifies the blood sample's ability to transport oxygen,[19] which
has led to reports that an "optimal hematocrit level" may exist. Optimal hematocrit
levels have been studied through combinations of assays on blood sample's hematocrit
itself, viscosity, and hemoglobin level.[19]

Hematocrit levels also serve as an indicator of health conditions. Thus, tests on

hematocrit levels are often carried out in the process of diagnosis of such conditions,[16]
and may be conducted prior to surgery.[7] Additionally, the health conditions associated
with certain hematocrit levels are the same as ones associated with certain hemoglobin
levels.As blood flows from the arterioles into the capillaries, a change in pressure
occurs. In order to maintain pressure, the capillaries branch off to a web of vessels that
carry blood into the venules. Through this process blood undergoes micro-circulation.
In micro-circulation, the Fåhræus effect will take place, resulting in a large change in
hematocrit. As blood flows through the arterioles, red cells will act a feed hematocrit
(Hf), while in the capillaries, a tube hematocrit (Ht) occurs. In tube hematocrit, plasma
fills most of the vessel while the red cells travel through in somewhat of a single file
line. From this stage, blood will enter the venules increasing in hematocrit, in other
words the discharge hematocrit (Hd).In large vessels with low hematocrit, viscosity
dramatically drops and red cells take in a lot of energy. While in smaller vessels at the
micro-circulation scale, viscosity is very high. With the increase in shear stress at the
wall, a lot of energy is used to move cells.[citation needed]
Shear rate relations
A man uses a hand centrifuge to analyse two test tubes with blood, Guinea-Bissau,
1973.

Relationships between hematocrit, viscosity, and shear rate are important factors to put
into consideration. Since blood is non-Newtonian, the viscosity of the blood is in
relation to the hematocrit, and as a function of shear rate. This is important when it
comes to determining shear force, since a lower hematocrit level indicates that there is a
need for more force to push the red blood cells through the system. This is because
shear rate is defined as the rate to which adjacent layers of fluid move in respect to each
other.[20] Plasma is a more viscous material than typically red blood cells[citation needed],
since they are able to adjust their size to the radius of a tube; the shear rate is purely
dependent on the amount of red blood cells being forced in a vessel.

Elevated

Generally at both sea levels and high altitudes, hematocrit levels rise as children mature.
[21]
These health-related causes and impacts of elevated hematocrit levels have been
reported:

 Fall in blood plasma levels[6]

 Dehydration[16]
 Administering of Testosterone supplement therapy[22]
 In cases of dengue fever, a high hematocrit is a danger sign of an increased risk
of dengue shock syndrome. Hemoconcentration can be detected by an escalation
of over 20% in hematocrit levels that will come before shock. For early
detection of dengue hemorrhagic fever, it is suggested that hematocrit levels be
kept under observations at a minimum of every 24 hours; 3–4 hours is suggested
in suspected dengue shock syndrome or critical cases of dengue hemorrhagic
fever. [23]
 Polycythemia vera (PV), a myeloproliferative disorder in which the bone
marrow produces excessive numbers of red cells, is associated with elevated
hematocrit.[citation needed]
 Chronic obstructive pulmonary disease (COPD) and other pulmonary conditions
associated with hypoxia may elicit an increased production of red blood cells.
This increase is mediated by the increased levels of erythropoietin by the
kidneys in response to hypoxia.[citation needed]
 Professional athletes' hematocrit levels are measured as part of tests for blood
doping or erythropoietin (EPO) use; the level of hematocrit in a blood sample is
compared with the long-term level for that athlete (to allow for individual
variations in hematocrit level), and against an absolute permitted maximum
(which is based on maximum expected levels within the population, and the
hematocrit level that causes increased risk of blood clots resulting in strokes or
heart attacks).[citation needed]
 Anabolic androgenic steroid (AAS) use can also increase the amount of RBCs
and, therefore, impact the hematocrit, in particular the compounds boldenone
and oxymetholone.[citation needed]
  Capillary leak syndrome also leads to abnormally high hematocrit counts,
because of the episodic leakage of plasma out of the circulatory system.[citation
needed]

 At higher altitudes, there is a lower oxygen supply in the air and thus hematocrit
levels may increase over time.[24]

Hematocrit levels were also reported to be influenced by social factors that influence
subjects. In the 1966–80 Health Examination Survey, there was a small rise in mean
hematocrit levels in female and male adolescents that reflected a rise in annual family
income. Additionally, a higher education in a parent has been put into account for a rise
in mean hematocrit levels of the child.[25]

Lowered

Lowered hematocrit levels also pose health impacts. These causes and impacts have
been reported:

 A low hematocrit level is a sign of a low red blood cell count. One way to
increase the ability of oxygen transport in red blood cells is through blood
transfusion, which is carried out typically when the red blood cell count is low.
Prior to the blood transfusion, hematocrit levels are measured to help ensure the
transfusion is necessary and safe.[26]
 A low hematocrit with a low mean corpuscular volume (MCV) with a high
RDW suggests a chronic iron-deficient anemia resulting in abnormal
hemoglobin synthesis during erythropoiesis.[27] The MCV and the red cell
distribution width (RDW) can be quite helpful in evaluating a lower-than-
normal hematocrit, because they can help the clinician determine whether blood
loss is chronic or acute, although acute blood loss typically does not manifest as
a change in hematocrit, since hematocrit is simply a measure of how much of the
blood volume is made up of red blood cells. The MCV is the size of the red cells
and the RDW is a relative measure of the variation in size of the red cell
population.
 Decreased hematocrit levels could indicate life-threatening diseases such as
leukemia.[28] When the bone marrow no longer produces normal red blood cells,
hematocrit levels deviate from normal as well and thus can possibly be used in
detecting acute myeloid leukemia.[29] It can also be related to other conditions,
such as malnutrition, water intoxication, anemia, and bleeding.[16]
 Pregnancy may lead to women having additional fluid in blood. This could
potentially lead to a small drop in hematocrit levels.[30]