# Low hematocrit = poor performance?



## RRRoubaix (Aug 27, 2008)

Got my blood test results- borderline anemia and really low Hct/Hb numbers.

The Red Cross website says they won't even let you give blood if your Hct is less than 38!
________________________________________
Blood counts showed: 
WBC (white blood cell count) is 5.6 10^9/L which is normal. (Normal range is 3.9-10.6)
Hemoglobin (a measure of red blood cells) is 12.4 which is low. (Normal range is 13.5-17.7)
Hematocrit (a measure of red blood cells) is 36.5 which is low. (Normal range is 40-53)
Platelet count (cells that help stop bleeding) is 248 10^9/L which is normal. (Normal range is 140-444)
Your anemia is mild and stable. There is no treatment or further workup needed at this time.
Please do not hesitate to call us should you have any further questions or concerns.
________________________________________--

Dunno what to do. That seems really low... am I wrong to be concerned about this? Wouldn't the low numbers affect my cycling/racing performance?
Not that there's much I can do...


----------



## kbwh (May 28, 2010)

Nutrition? Just a thought.


----------



## MikeBiker (Mar 9, 2003)

It wouldn't hurt to have a physician check you over to see if there is a findable cause for the low red blood cell count.


----------



## RRRoubaix (Aug 27, 2008)

My doctor seems to think that's "just how my body is"- and he's right, I've been borderline anemic for years. I wasn't aware of the Hct/Hb levels before, but I never paid attention.

As far as nutrition, always possible, but my diet is pretty dang healthy- small portions, no crap food, maybe too low on calories though (which could also explain my chronic fatigue- but then so could a zillion other things).


----------



## brianmcg (Oct 12, 2002)

Take more iron and eat more red meat. Rinse and repeat.


----------



## crazyc (Jun 5, 2008)

not a primary care doc but a few questions.

How does he know that is just the way you are? Were any specific work ups
done. What is the reason for the low H/H? 

anemia is due to 3 main reasons - decreased production, increased destruction, and
blood loss. Within these 3 groups are numerous subgroups. A more focused work
up can ususally zero in on the root cause.

such testing can include reticulocyte counts, ferritin levels, iron levels, MCV's, MCH's,
MCHC's, and RDW's. These tests can give you specific reason for your anemia. I
don't think I would settle for "just the way you are" with out knowing more information.

If it is just the way you are and experienceing fatigue can anything be done to increase red cell production such as EPO or nutritional supplements. hope this helps a little.


----------



## RRRoubaix (Aug 27, 2008)

crazyc said:


> not a primary care doc but a few questions.
> 
> How does he know that is just the way you are? Were any specific work ups
> done. What is the reason for the low H/H?
> ...


Good post! :thumbsup:
Hmm... I'm guessing I would notice blood loss (not being facetious), so that would narrow it down to decreased production or increased destruction...
Would decreased production be a normal effect from aging? (I'm nearly 50)
As for increased destruction, it's certainly possible- what would be getting destroyed? Is there something I should be looking for?

I expressed my concern and asked what I could do to boost my numbers, especially since I'm an athlete (I know, it's a stretch, but technically true!). I asked about iron supplements, red meat, nuts, all that stuff (which I already eat). My GP seemed very unconcerned. He didn't quite blow me off, but nearly.
I'm sure he wouldn't okay any additional bloodwork... However, I have heard some athletes get their blood checked 2-3 times a year- mebbe I could make an appt for the end of cross season...


----------



## RRRoubaix (Aug 27, 2008)

brianmcg said:


> Take more iron and eat more red meat. Rinse and repeat.


Ha ha! Well, my cholesterol numbers were incredibly good, so I guess I can afford to eat more red meat. Bacon cheeseburgers, here I come!
I did start taking iron again...
Although I really wonder just how much those things can help your Hct and Hg numbers... (i.e . could I go from 36.5 to 45 or are we talking more like 36.5 all the way up to 37.8 :cryin


----------



## bikerjulio (Jan 19, 2010)

I got a low RBC count too. It's a hereditary syndrome. Didn't stop me getting the 2nd highest VO2 max score my clinic had ever seen when i was a skinny runner. Doesn't hold me back on the bike either. Nothing will change it btw.


----------



## RRRoubaix (Aug 27, 2008)

bikerjulio said:


> I got a low RBC count too. It's a hereditary syndrome. Didn't stop me getting the 2nd highest VO2 max score my clinic had ever seen when i was a skinny runner. Doesn't hold me back on the bike either. Nothing will change it btw.


Fair enough... Good to know- on both counts!
Thanks for the info.


----------



## OldEndicottHiway (Jul 16, 2007)

Crazyc posted well. 

If he/she went into all the differing reasons for borderline low hematocrit, your head would spin.

Your "anemia" is very mild.

There are numerous studies into etiologies behind sub-optimal hematocrit, and I could post some links, but they would probably only make you a hypochondriac. 

Crazyc is right in that if you dig enough, you can probably find your specific cause for your mild, longstanding anemia. But do you need to? Doubtful, unless the "fix" is insanely simple.

By simple...have you had a complete iron panel done (easy to do...it's just a lab draw)? However, if you have a good diet, this is unlikely the cause. Good diet means your B-12 and Folate levels are probably also fine.

Other factors, including certain types of endogenous "Epo resistance" are not "fixable" and not worth worrying about imho.


----------



## psycleridr (Jul 21, 2005)

Just out of curiosity are you having any physical symptoms due to your lower than avg levels? Do you feel fatigued? Are you often running out of energy?
I don't disagree that looking into it a little more than that is just the way you are thing but is there actually something wrong other than the numbers not fitting the average?


----------



## MR_GRUMPY (Aug 21, 2002)

Mine's F'ed up too. This year it was 43, last year was 37 Bone head doctor didn't think it was any problem. (I was thinking of trying to hit him up for some EPO)


----------



## QED (Aug 11, 2011)

I have had a low iron levels for as long as I can remember. It is always hit or miss whether I can give blood. My hematocrits have ranged from 32 to 36. They have never found anything physically wrong. And neither iron, diet changes nor anything has ever made it come up to "normal". Several doctors have told me that it is normal for me. Healthy, active, low cholesteral, no worries.


----------



## spade2you (May 12, 2009)

I tend to have a high hemoglobin and hematocrit, although my performances haven't been anything to write home about. 

Anyway, on top of what has already been said, perhaps look at some sort of colonoscopy to see if the blood levels are from some sort of upper or lower GI bleed. Perhaps not, but one possibility, not to scare you.


----------



## RRRoubaix (Aug 27, 2008)

Great information, everyone- thank you.
I do feel plenty of fatigue, but it's probably due more to sleep patterns and work stress (and age) than low Hct/Hg numbers.
I guess the biggest problem for me is mainly mental- I DNF'd today in our state XC championship- not mechanical, just physically toasted. There are plenty of reasons why, but now I wonder if I've just given myself another "out".

I probably just need to HTFU!!
(Especially w/ cross season just around the corner)


----------



## heathb (Nov 1, 2008)

Have you had your testosterone levels checked?


----------



## spade2you (May 12, 2009)

heathb said:


> Have you had your testosterone levels checked?


I think there's a new drug out because docs are on a testosterone kick lately. Be forewarned that it's an uphill battle getting a therapeutic exemption approved for testosterone.


----------



## Brad the Bold (Jun 8, 2010)

RRRoubaix said:


> Good post! :thumbsup:
> Hmm... I'm guessing I would notice blood loss (not being facetious), so that would narrow it down to decreased production or increased destruction...
> Would decreased production be a normal effect from aging? (I'm nearly 50)
> As for increased destruction, it's certainly possible- what would be getting destroyed? Is there something I should be looking for?
> ...


Also a doc, but not primary care. I have to echo CrazyC's concern. 

Anemia is a non specific finding but it is still more likely to be a herald of a significant medical propblem than a "Just the way you are" finding.

I'd also correct you on your guess that you would "notice blood loss". True, if it's external blood loss from say, that amutated limb. Not true if it's internal from your bleeding ulcer or colon cancer. Gastrointestinal bleeding is a very common cause of occult blood loss and anemia. Depending on you age and your history you should at least have a fecal occult blood screen. If you are older, consider a GI consult and a colonoscopy.


----------



## heathb (Nov 1, 2008)

spade2you said:


> I tend to have a high hemoglobin and hematocrit, although my performances haven't been anything to write home about.
> 
> Anyway, on top of what has already been said, perhaps look at some sort of colonoscopy to see if the blood levels are from some sort of upper or lower GI bleed. Perhaps not, but one possibility, not to scare you.


I would just get a 3 fecal blood cards at the doctors office and do that for 3 days in a row. He'd also notice black tar stools and some really rotten smelling bowel movements if he had a GI bleed.


----------



## tarwheel2 (Jul 7, 2005)

It definitely could affect performance. I typically have high red blood counts. However, one of the most difficult rides I ever did was several days after giving blood. It was an extremely hilly route, and I thought I was gonna die. I rarely donate blood anymore because I ride almost every day and it's very hilly where I live, and I just don't want to suffer like that if I can help it.


----------



## spade2you (May 12, 2009)

heathb said:


> I would just get a 3 fecal blood cards at the doctors office and do that for 3 days in a row. He'd also notice black tar stools and some really rotten smelling bowel movements if he had a GI bleed.


That could give the official diagnosis. Could also be pissing it away in small amounts. I just figured the OP was at that age or about that age to get that checked, anyway.


----------



## Kerry Irons (Feb 25, 2002)

*Iron intake*



crazyc said:


> not a primary care doc but a few questions.
> 
> How does he know that is just the way you are? Were any specific work ups
> done. What is the reason for the low H/H?
> ...


Having been through this myself, I agree completely that the OP needs to learn about serum iron and ferritin levels. It is quite possible that the OP just has poor iron uptake from diet. I got into some low Hct readings and my serum iron and ferritin levels were at the bottom of the range. My diet was already well over 200% of RDA, but I was just not absorbing the iron from the gut. 

Taking iron supplements raised my Hct from 37 to 43 and increased my power on the bike by 12% (as measured in flat road time trial speeds). Even with the iron supplememts, by ferritin and serum iron were still at the low end of the range so no risk of hemochromatosis.


----------



## burgrat (Nov 18, 2005)

My last blood panel showed a hemocrit level of 48 and I'm slow as hell.


----------



## jmitro (Jun 29, 2011)

some of the concerns about "low hematocrit" and getting a workup here are overrated IMHO.

I never look at hematocrit, but hemoglobin instead as a measure of anemia. That's just the way I was trained. The hemoglobin carries the oxygen, not hematocrit. The "crit" can vary based on hydration status of the patient.

Regardless, keep in mind the "normal values" on the lab sheet are fairly arbitrary, not constant. They are set from a set of normalized values from a bell-shaped curve...... Normalized values at one lab are not the same as at another lab facility, although they are fairly close. Just because you may be "slightly low" is not an indication of a problem. If every patient I saw got a colonoscopy (or a hysterectomy in my profession) because of a low hematocrit, there would be a lot of unnecessary procedures done.

I agree with healthy eating, but would not attribute poor bike performance to a borderline low HCT.

I


----------



## jmitro (Jun 29, 2011)

RRRoubaix said:


> The Red Cross website says they won't even let you give blood if your Hct is less than 38!


with all due respect, that means absoltutely nothing. I got turned down as a collegiate long distance runner from donating blood b/c my heart rate was too low!! Blood donation organizations have a protocol to follow that protects them from accepting blood donations from persons who are unhealthy, but they don't think outside the box when it comes to making exceptions.


----------



## Kerry Irons (Feb 25, 2002)

*Broad statements*



jmitro said:


> some of the concerns about "low hematocrit" and getting a workup here are overrated IMHO.
> 
> I never look at hematocrit, but hemoglobin instead as a measure of anemia. That's just the way I was trained. The hemoglobin carries the oxygen, not hematocrit. The "crit" can vary based on hydration status of the patient.
> 
> ...


Be careful with the broad statements. I have had several phlebotomists tell me that Hct and Hb are pretty much in lock step for most people (3X Hb = Hct). Obviously not a lab quality result, but close enough given all the other variables.

Though you would not attribute poor bike performance to borderline low Hct, that is EXACTLY my situtation. If you had read my post: Hct of 37, one minute slower in a 10 mile time trial, started iron supplements and got the minute back (Hct rose to 42-44). I'm not saying that anyone with a low Hct will suffer loss of performance, but you cannot say they are not ever related.


----------



## jmitro (Jun 29, 2011)

Kerry Irons said:


> Be careful with the broad statements. I have had several phlebotomists tell me that Hct and Hb are pretty much in lock step for most people (3X Hb = Hct). Obviously not a lab quality result, but close enough given all the other variables.
> 
> Though you would not attribute poor bike performance to borderline low Hct, that is EXACTLY my situtation. If you had read my post: Hct of 37, one minute slower in a 10 mile time trial, started iron supplements and got the minute back (Hct rose to 42-44). I'm not saying that anyone with a low Hct will suffer loss of performance, but you cannot say they are not ever related.


with all due respect, do YOU know what a phlebotomist is? It's a skilled lab technician that draws blood. I'll take my 5yrs college, 4yrs med school, 4 yrs residency, and 7 yrs in private practice as much more education than a phlebotomist will ever have. Again, I mean that with NO disrespect, but you have to consider your source of information. It's kinda like trusting the local 20 year old bike mechanic to be an expert in repairing your cracked carbon fiber frame. Sure, he knows what CF is, but he does not have the mechanical, structural, or engineering background to know how to assess and repair it correctly. :thumbsup::thumbsup:

Additionally, the contention that your performance rose SOLELY due to a rise in HCT is strictly anecdotal and highly unlikely as there are SO many variables that would contribute to a time difference. Wind, temperature, tire pressure, restfulness, nutritional state, training differences are ALL factors that affect performance (and many more). My hematocrit changes on a daily basis.....seriously. We check labs on patients in the hospital on a serial basis, and the values CHANGE ON A DAILY BASIS. 

I'm not arguing against increasing hematocrit (quite the contrary) but I AM arguing that some recommendations and statements in this thread are strictly based on one's own experiences and not scientifically sound. :thumbsup:


----------



## OldEndicottHiway (Jul 16, 2007)

jmitro said:


> with all due respect, do YOU know what a phlebotomist is? It's a skilled lab technician that draws blood. I'll take my 5yrs college, 4yrs med school, 4 yrs residency, and 7 yrs in private practice as much more education than a phlebotomist will ever have. Again, I mean that with NO disrespect, but you have to consider your source of information. It's kinda like trusting the local 20 year old bike mechanic to be an expert in repairing your cracked carbon fiber frame. Sure, he knows what CF is, but he does not have the mechanical, structural, or engineering background to know how to assess and repair it correctly. :thumbsup::thumbsup:
> 
> Additionally, the contention that your performance rose SOLELY due to a rise in HCT is strictly anecdotal and highly unlikely as there are SO many variables that would contribute to a time difference. Wind, temperature, tire pressure, restfulness, nutritional state, training differences are ALL factors that affect performance (and many more). My hematocrit changes on a daily basis.....seriously. We check labs on patients in the hospital on a serial basis, and the values CHANGE ON A DAILY BASIS.
> 
> I'm not arguing against increasing hematocrit (quite the contrary) but I AM arguing that some recommendations and statements in this thread are strictly based on one's own experiences and not scientifically sound. :thumbsup:



Browsing past here... Imho, neither one of you are "wrong" at any point in your posts ...although the same thing stuck out at me as it did you...increased performance with increased hct in KI's example, is anecdotal, though not to be written off.

There are too many variables to attribute a percevied or real increased or decreased performance to a (relatively) slight variance in hct/hgb level.

This thread only serves to remind that...there are docs who specialize in hematology precisely because it is so _incredibly_ complex.

Good stuff in this thread, though. And thanks for your insight, jmitro.


----------



## bradXism (May 10, 2011)

Brad the Bold said:


> Also a doc, but not primary care. I have to echo CrazyC's concern.
> 
> Anemia is a non specific finding but it is still more likely to be a herald of a significant medical propblem than a "Just the way you are" finding.
> 
> I'd also correct you on your guess that you would "notice blood loss". True, if it's external blood loss from say, that amutated limb. Not true if it's internal from your bleeding ulcer or colon cancer. Gastrointestinal bleeding is a very common cause of occult blood loss and anemia. Depending on you age and your history you should at least have a fecal occult blood screen. If you are older, consider a GI consult and a colonoscopy.


Not a primary doc either

Agree with the above advises and concerns

Spleen enlarged?, A bilirubin level? Family history, etc.

There is too little info here to give a straight answer. I wouldn't advise you look too much into it on the net because there are some rare things ,it def isn't, that could scare the hell out of you. If you have a lot of unanswered questions and aren't getting answers, you could always try another Physician.


----------



## rockdude (Apr 3, 2008)

I didn't sleep in a holiday inn express last night but increasing Hct levels has a very strong correlation with improved aerobic performance.


----------



## Brad the Bold (Jun 8, 2010)

jmitro said:


> some of the concerns about "low hematocrit" and getting a workup here are overrated IMHO.
> 
> I never look at hematocrit, but hemoglobin instead as a measure of anemia. That's just the way I was trained. The hemoglobin carries the oxygen, not hematocrit. The "crit" can vary based on hydration status of the patient.
> 
> ...


Per the original post, his hemoglobin is also low.


----------



## Kerry Irons (Feb 25, 2002)

*Details*



jmitro said:


> with all due respect, do YOU know what a phlebotomist is? It's a skilled lab technician that draws blood. I'll take my 5yrs college, 4yrs med school, 4 yrs residency, and 7 yrs in private practice as much more education than a phlebotomist will ever have.


As I said, Hct/3 does NOT equal a lab result, but the phlebotomists I have talked to have worked in blood banks and hospital labs for 20+ years. They see a LOT of lab results and that's where their rule of thumb comes from. Of course there are exceptions and you shouldn't depend on Hct to get Hb but I'm willing to bet that a full statistical analysis of a large number of Hct and Hb analyses (for "normal" people) would show a stronger correlation than a lot of things that the medical profession considers to be well-correlated.



jmitro said:


> Additionally, the contention that your performance rose SOLELY due to a rise in HCT is strictly anecdotal and highly unlikely as there are SO many variables that would contribute to a time difference. Wind, temperature, tire pressure, restfulness, nutritional state, training differences are ALL factors that affect performance (and many more). My hematocrit changes on a daily basis.....seriously. We check labs on patients in the hospital on a serial basis, and the values CHANGE ON A DAILY BASIS.


I give blood several times per year and ride 15+ 10 mile time trials every year on the same course. The numbers I quoted are based on comparing 15 years of blood donation Hct numbers and roughly 200 time trial results with Hct numbers in the low-mid 40s followed by 4 years of Hct numbers around 38 and roughly 50 time trials followed by iron supplementation and 5 years of Hct back in the low-mid 40s and another 75+ time trial results. NONE of the factors you mention are variables in my data (same annual mileage, same riding style, same diet, same lifestyle). The only variable was the drop in Hct correlating with a 1 mph drop in TT speed and the iron supplements resulting in a "return to normal" Hct and a 1 mph increase in TT speed. You are speaking generalities; I am referencing a lot of data.

With all due respect, I find that the medical profession is not that great at understanding statistical significance, base line data, and correlations. PSA tests for prostate cancer are a perfect example where the recommendations are based on a specific threshold number rather than a change from baseline data. My PSA tests have come back consistently at 0.3-0.4 for two decades. If they rose to 3.5, I would be concerned but the medical guidelines say no worries if below 4.0. Just one example.


----------



## RRRoubaix (Aug 27, 2008)

Wow! I'm glad I posted this. 
All kinds of interesting stuff has come up. Great info, everyone!!:thumbsup:

No, I don't have a clear idea of what -if anything- to do. But it does appear that I shouldn't be overly concerned.


----------



## OldEndicottHiway (Jul 16, 2007)

Kerry Irons said:


> As I said, Hct/3 does NOT equal a lab result, but the phlebotomists I have talked to have worked in blood banks and hospital labs for 20+ years. They see a LOT of lab results and that's where their rule of thumb comes from....*With all due respect, I find that the medical profession is not that great at understanding statistical significance, base line data, and correlations. PSA tests for prostate cancer are a perfect example where the recommendations are based on a specific threshold number rather than a change from baseline data. My PSA tests have come back consistently at 0.3-0.4 for two decades. If they rose to 3.5, I would be concerned but the medical guidelines say no worries if below 4.0. Just one example.[/*QUOTE]
> 
> You speak of "general" medical professionals, then.
> 
> ...


----------



## bradXism (May 10, 2011)

OldEndicottHiway said:


> Kerry Irons said:
> 
> 
> > ...*With all due respect, I find that the medical profession is not that great at understanding statistical significance, base line data, and correlations.[/*QUOTE]
> ...


----------



## SKIBUMM (Feb 26, 2010)

I agree with the PHD here, as a hematologist, there are many causes of anemia all from three main areas that have already been noted. I would get bloodwork done and included in the already mentioned tests I would find a lab that can run either a RetHe or a CHR (same test different name) and find out how your retics are carrying hemaglobin. Even though your numbers are still within limits they are low enough that I would not accept "that is just how you are". Also don't count our Bloodloss as many times you will not know if you are losing blood internally unless you are looking for it specifically.


----------



## jmitro (Jun 29, 2011)

Kerry Irons said:


> I give blood several times per year and ride 15+ 10 mile time trials every year on the same course. The numbers I quoted are based on comparing 15 years of blood donation Hct numbers and roughly 200 time trial results with Hct numbers in the low-mid 40s followed by 4 years of Hct numbers around 38 and roughly 50 time trials followed by iron supplementation and 5 years of Hct back in the low-mid 40s and another 75+ time trial results. NONE of the factors you mention are variables in my data (same annual mileage, same riding style, same diet, same lifestyle). The only variable was the drop in Hct correlating with a 1 mph drop in TT speed and the iron supplements resulting in a "return to normal" Hct and a 1 mph increase in TT speed. You are speaking generalities; I am referencing a lot of data.
> 
> With all due respect, I find that the medical profession is not that great at understanding statistical significance, base line data, and correlations......


LOL, just coming back to this thread.
You certainly have the numbers to do a good before/after comparison. I'd still argue that you have to eliminate all other variables to make a scientifically sound conclusion. Were you the exact same weight every TT? Same weekly mileage? Same weather temperature and wind conditions? Same state of restfulness with each TT? If all those were identical with each ride, you could say conclusively your performance change was due to HCT. Nonetheless it appears there is validity to your argument, as higher N (volume) reduces the effects of other variables.

I would disagree with your statement re med professionals and statistical significance. That is exactly what we are trained to evaluate.....especially academians and researchers (which I am not....my personal knowledge of statistics sucks, LOL. But at least I know what it's supposed to mean) :thumbsup:


----------



## oily666 (Apr 7, 2007)

brianmcg said:


> Take more iron and eat more red meat. Rinse and repeat.


:thumbsup:


----------



## DonDenver (May 30, 2007)

To oily666 thumbs-up of Brianmcg's post...review web examples of those associated foods that help not inhibit your body to uptake iron (foods/supplements in combination on your dinner plate). Nevertheless, anything to an extreme and quickly may not be beneficial...eat balanced with an eye towards better iron rich food source and then confirm near three months with a look at the next blood test markers. Here's to your improved health :thumbsup:


----------



## Kerry Irons (Feb 25, 2002)

*Controlling factors*



jmitro said:


> LOL, just coming back to this thread.
> You certainly have the numbers to do a good before/after comparison. I'd still argue that you have to eliminate all other variables to make a scientifically sound conclusion. Were you the exact same weight every TT? Same weekly mileage? Same weather temperature and wind conditions? Same state of restfulness with each TT? If all those were identical with each ride, you could say conclusively your performance change was due to HCT. Nonetheless it appears there is validity to your argument, as higher N (volume) reduces the effects of other variables.
> 
> I would disagree with your statement re med professionals and statistical significance. That is exactly what we are trained to evaluate.....especially academians and researchers (which I am not....my personal knowledge of statistics sucks, LOL. But at least I know what it's supposed to mean) :thumbsup:


I have been riding the same weekly mileage and eating essentially the same diet for decades. Wather and temperature are obviously variables, but I plot my speeds throughout the season and then run averages throwing out the high and the low.

There are a number of tests for which at least some fraction of the medical community there is not much logic or statistical reference. If you run a PSA of 0.5 for years and then it spikes to 3, you likely have a problem but according to the standards, you only need worry if it goes above 4. Many other examples (blood lipids, body mass index, blood pressure, etc) where the medical community seems to think there are on/off zones of concern without looking at the big picture.


----------



## jmitro (Jun 29, 2011)

agree that one must look at the big picture. that's why PSA is only a screening test, not a diagnostic test. prostate biopsy would be the diagnostic test. Spike in PSA might be cause for concern. I'd say it also depends on the interpreting physician/provider. Some providers might not be concerned about a spike that is still within normal limits, but others would.


----------



## Deering (Apr 10, 2007)

Quick question, it was mentioned that anemia is due to decreased production, increased destruction and blood loss. What about Thalassemia? Wouldn't that cause a lower hematocrite too? Not sure how thalassemia relates to performance.


----------

