In male the normal range of hemoglobin is upto 18, hematocrit (pcv) is upto 52%. But recent WHO CRITERIA FOR diagnosis FOR polycythemia IS Hemoglobin 16.5, hemotocratic (pcv) 49% These both concepts do not go hand in hand why? On one hand normal range suggests higher values of hemoglobin and hematocrit than 2016 criteria for polycythemia. Please explain.

Dr. Dibyendu DeHematologist12yrs exp

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The normal range for Hemoglobin is 13-17g/dl for male and 12-15 g/dl for female. However recent update in WHO diagnostic criteria for Polycythemia Vera has Hemoglobin cut-off of 16.5, which has mild overlap with normal range. This is because, the concept of disease etiology has undergone sea change with the newer highlights on genetic mutations and it is found that few people who otherwise have high normal hemoglobin level can have the genetic mutations and thus develops full blown polycythemia vera, as time flies by. Therefore, if someone have high normal hemoglobin, even though it falls well within normal range, the physicians should be alert of possibility of polycythemia vera and should prescribe for bone marrow studies and genetic studies, which are essential for diagnosis of polycythemia vera. (sole increase in Hemoglobin level above 16.5 gm/dl is not sufficient for diagnosis ). This helps in starting patients with preventive measures, so that life threatening complications of polycythemia vera, like stroke or AMI, can be prevented. Hope it helps and clarifies your doubts thanks.  

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