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Blood Basics: What Is Hemoglobin?

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Published on October 4, 2021

The Relationship Between Hemoglobin and Fatigue

What is hemoglobin? Are low hemoglobin levels related to fatigue? Follow along as Patient Power co-founder Andrew Schorr sits down with Susan Leclair, PhD, CLS (NCA), Chancellor Professor Emerita at the University of Massachusetts Dartmouth, to learn more about hemoglobin and the impact it has on individuals with blood cancer.

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Transcript | Blood Basics: What Is Hemoglobin?

Andrew Schorr: Hello, and welcome to Patient Power. I'm Andrew Schorr and we're discussing blood basics. So some of us have hemoglobin, which is one of the things measured in your blood testing typically, that's lower. Well, with us is Dr. Susan Leclair, a laboratory science expert. Susan, thank you for joining us. What is hemoglobin? What is it and what does it have to do with us feeling fatigued?

What Is Hemoglobin?

Dr. Leclair: Okay. It's actually a very complex protein that I will not discuss its structure because we could be here forever on it. Basically, think of hemoglobin as a ring. You have the big ring, you have the setting, and then you have stones in the ring. The ring in hemoglobin is made of protein, it's made of globulin. Hemoglobin, it's a globulin. The setting is something called heme, hemoglobin, and the stone inside the ring is iron. If you think about that, that's not going to be too bad. Hemoglobin is the only reason you have a red cell in the first place, because you need to bring oxygen from the lungs to every part of your body, take carbon dioxide, and bring it back to the lungs to be exhaled.

How do you do that? Well, you need a carrier. You need something that's going to be able to pick up oxygen, hold onto it, and then drop it off as needed. That's hemoglobin. Hemoglobin can hold four molecules of oxygen, every single molecule. So if you have a hundred molecules of hemoglobin, you can hold four oxygen molecules. To a certain extent, the more hemoglobin you have, the better, because that means when that hemoglobin comes into the lungs, the red cell marches into the lungs. You got a lot of different settings that can reach out and grab four, hopefully, molecules of oxygen to bring it to the cells. If you have fewer red cells, you have less hemoglobin. If you have damaged cells, you have less hemoglobin. So instead of having 100 molecules getting into an area, picking up 400 molecules of oxygen, maybe you only have 80. I shouldn't have used that, it's a bad math thing. Eighty, that would be 320 molecules of oxygen.

Well, what do you need oxygen for? You need oxygen to give energy to your cells. The lower amount of oxygen you have, the tired-er those cells are going to get. Because they have less energy. Does that make sense? How do you get lower hemoglobin? Well, you can lose cells, that would be a way of doing it. Maybe you don't have enough protein, so you can't make the ring. Or maybe you damaged the heme portion, the setting, so you can't hook anything onto it. Well, maybe-

Andrew Schorr: You don't have enough iron.

Dr. Leclair: Right, you don't have enough iron. The single most common anemia in the world today is iron lack. Now there are a variety of ways to get it, but if you're missing the stone, and it's kind of easy to put the stone back into the setting. It's harder to fix the setting and harder still to fix the ring itself, but you need the complete ring in order to do it. And the thing that I love, it's a personal thing, people are just going to have to deal with this, when you look at this structure of hemoglobin, when it doesn't have oxygen, it kind of looks like this. When it gets into the lungs, it literally opens up to pick up the oxygen, and then closes down.

Andrew Schorr: It's an oyster.

Dr. Leclair: So it's almost like it's an oyster or it's breathing for you. Now, you can imagine, I've never understood this, but runners many times run on some of the most clogged and congested roads in our area. So, they're standing there at a light breathing in all of the exhaust from the cars, how much oxygen are they going to get? They may have plenty of hemoglobin, but they're breathing in less oxygen, more carbon dioxide or carbon monoxide from the exhaust. So you can get lowered oxygen by having less hemoglobin in numbers, or you can have less oxygen by breathing in contaminated air, or maybe having something wrong with your lungs, like you've got fluid in them.

Andrew Schorr: Or being at altitude, being at high altitude. So let me just tie this back to fatigue, so we're really clear on this. So, for those of us who have lower hemoglobin numbers on their blood test, that means that the red cell hemoglobin caring ability is decreased-

What Is the Relationship Between Low Hemoglobin Levels and Fatigue?

Dr. Leclair: It's lessened, right.

Andrew Schorr: There's less of it, less oxygen getting around the body, the cells get tired, we feel fatigued. Did I get it right?

Dr. Leclair: The best example of that is for everybody who's a football or a baseball fan in the United States — we just had the All-Star Game and so it's even a better one — what was everybody talking about, about the All-Star Game? There were going to be really big home runs and they were going to go really far because the air is thinner at higher altitude. Maybe I shouldn't be saying this, but why do the Denver Broncos and the Rockies have such a good record at home? Because they're used to breathing at that level, they have more hemoglobin than somebody who lives in San Diego. So when the San Diego Padres go to the Rockies, the San Diego Padres are at a disadvantage because they don't have enough hemoglobin.

Andrew Schorr: Okay. And so, for those of us who are cancer patients or situations with lower hemoglobin, we're just struggling a bit-

Dr. Leclair: That's right.

Andrew Schorr: ... for oxygen.

Dr. Leclair: You tend to cope — that'd be a good word for it — till your hemoglobin gets down to around a 10 or 11 and then coping becomes noticeable. Like at 50 grams of hemoglobin, you run up a flight of stairs, and at 11 grams of hemoglobin, you walk up the stairs, maybe a little slow, but it doesn't bother you. At 10 grams of hemoglobin or at nine grams of hemoglobin, you're stopping along the stairs-

Andrew Schorr: You're out of breath. I know it.

Dr. Leclair: ... to catch your breath. Yes.

Andrew Schorr: Okay, thank you so much for explaining hemoglobin, oxygen-carrying ability, with your wedding ring, et cetera, and fatigue. Doctor-

Dr. Leclair: I use whatever AV aids are available.

Andrew Schorr: Thank you. Susan Leclair and Andrew Schorr reminding you, that knowledge can be the best medicine of all.

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