Hematocrit (Ht): Normal Values, Causes of Abnormalities, and Interpretation | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Hematocrit measures the proportion of red blood cells in the blood. Low hematocrit (anemia), high hematocrit (polycythemia): interpretation, causes, and management in Quebec.\">\n<meta name=\"keywords\" content=\"h\u00e9matocrite valeurs normales, h\u00e9matocrite bas an\u00e9mie, h\u00e9matocrite \u00e9lev\u00e9 polyglobulie, h\u00e9matocrite interpr\u00e9tation, h\u00e9matocrite grossesse, h\u00e9matocrite d\u00e9shydratation, h\u00e9matocrite NFS Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Hematology & Family Medicine & Internal Medicine<\/span>\n <h1>Hematocrit (Hct)<\/h1>\n\n <div class=\"co-intro\">\n Hematocrit (Ht), also known as packed cell volume (PCV), expresses the volume fraction occupied by red blood cells (erythrocytes) in a given volume of whole blood. It is expressed as a percentage (%) or as a decimal fraction (L\/L). Measured on modern hematology machines by indirect calculation (Ht = RBC \u00d7 VGM \/ 10), or historically by capillary centrifugation (microhematocrit), it is one of the most widely used blood count parameters in clinical practice. Normal adult hematocrit values are 41 to 53 % in men and 36 to 46 % in women, with significant physiological variations depending on age (infant: 33-55 %, newborn: up to 65 %), pregnancy (physiological hemodilution \u2192 Ht may drop to 32-34 %) and altitude (hypoxia-adaptation polycythemia). Hematocrit is closely related to hemoglobin (Hb) by the approximate relationship: Hb (g\/dL) \u2248 Ht (%) \/ 3. A low hematocrit indicates anemia (reduced erythrocyte mass or plasma dilution), while a high hematocrit suggests polycythaemia (true or relative due to hemoconcentration). Interpretation of the hematocrit is always contextual - it is integrated into the complete blood count with the mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), reticulocytosis and erythrocyte indices to guide the etiological diagnosis.\n <\/div>\n\n <h2>Physiology, Reference Values, and Relationships with Other Erythrocytic Parameters<\/h2>\n <ul class=\"co-list\">\n <li><strong>Definition, measurement methods, and calculation:<\/strong> definition: hematocrit represents the ratio of red blood cell volume to total blood volume \u2192 Ht = RBC volume \/ total blood volume \u00d7 100 \u2192 in practice on an automated system: Ht (%) = RBC (\u00d710\u00b9\u00b2\/L) \u00d7 GMV (fL) \/ 10 \u2192 this formula gives the calculated hematocrit (slightly higher than measured by centrifugation due to residual plasma trapped between RBCs - \u00abtrapped plasma\u00bb - approximately 1-3 % difference); historical method (microhematocrit): capillary or venous blood in a heparinized capillary tube \u2192 centrifugation 10,000 g \u00d7 5 min \u2192 direct reading of the height of the RBC column in relation to the total volume \u2192 reference method (Gold Standard) for detecting certain morphological abnormalities in RBCs (visible buffy coat) \u2192 microhematocrit method still used in pediatrics + in emergency (arterial blood gases \u2192 co-oxymeter); hematology automata (Sysmex XN + Beckman-Coulter DxH): hematocrit is calculated from RBC counting by electrical impedance (Coulter method) and VGM measurement \u2192 more reproducible result than microhematocrit + available in seconds + hematocrit-hemoglobin-VGM relationship: fundamental formulas: Ht \u2248 Hb \u00d7 3 (rule of thirds - clinical approximation) + VGM = Ht \/ GR \u00d7 10 (fL) + CCMH = Hb \/ Ht \u00d7 100 (g\/dL) + TCMH = Hb \/ GR \u00d7 10 (pg) \u2192 example: Ht 36 % + GR 3.8 \u00d7 10\u00b9\u00b2\/L + Hb 12 g\/dL \u2192 VGM = 36 \/ 3.8 \u00d7 10 = 94.7 fL (normocytic) + CCMH = 12 \/ 0.36 = 33.3 g\/dL (normochromic)<\/li>\n <li><strong>Normal values by age, sex, and physiological conditions:<\/strong> adult reference values (Canadian laboratories - venous plasma - calibrated automatons): adult male (18-65 years): 41-53 % + adult female (18-65 years): 36-46 % \u2192 male-female difference: due to androgens (testosterone stimulates erythropoiesis \u2192 GR + Hb + Ht higher in men) + menstrual iron loss (Ht lower in women of childbearing age); age variations: newborn (birth): 44-64 % \u2192 physiological polyglobulia (intense fetal erythropoiesis + predominant fetal Hb HbF) \u2192 physiological neonatal hemolysis \u2192 drops to 30-40 % at 2-3 months (physiological nadir) + infant 6 months-2 years: 33-40 % + child 2-12 years: 35-45 % + adolescent: gradually towards adult values (M\/F divergence at puberty) + elderly (>70 years): slight physiological decline accepted (Ht >36 % man + >33 % woman) - NB: anemia should not be attributed to aging alone without investigation + altitude: hypoxia \u2192 increased EPO \u2192 stimulation of erythropoiesis \u2192 higher Ht \u2192 at 3,000 m: Ht can reach 55-60 % + at 4,500 m (Himalayas + Andes): 60-65 % + pregnancy: physiological hemodilution (increase in plasma volume of 40-50 % + lesser increase in erythrocyte mass of 20-30 %) \u2192 drop in Ht to 32-34 % in the 2nd-3rd trimester \u2192 non-pathological physiological anemia \u2192 WHO threshold for anemia in pregnancy: Hb <110 g\/L (Ht <33 %) in 1st and 3rd trimester + Hb <105 g\/L (Ht <32 %) in 2nd trimester + smoking: slight rise in Ht (smoking polyglobulia - carboxyhemoglobin \u2192 relative tissue hypoxia \u2192 EPO stimulation) + intense, chronic physical training (endurance athletes): proportionally greater increase in plasma volume \u2192 \u00absportsman's anemia\u00bb (lowered Ht despite normal erythrocyte mass)<\/li>\n <li><strong>Hematocrit and blood volume - distinction between true polycythemia and relative polycythemia:<\/strong> fundamental concept: hematocrit measures a fraction (RBC \/ total blood volume) \u2192 may be elevated either because total erythrocyte mass is increased (polyglobulia vera) or because plasma volume is reduced (relative polyglobulia by hemoconcentration) \u2192 essential distinction because treatment is radically different; relative polyglobulia (hemoconcentration) : causes: dehydration (gastroenteritis + heat + excessive sweating + vomiting + profuse diarrhea) + Gaisbock syndrome (relative polyglobulia of stressed hypertensive heavy smoker + no increase in erythrocyte mass) + diuretics + extensive burns (plasma loss) \u2192 high Ht + normal or reduced total blood volume + normal reticulocytes + normal EPO \u2192 treatment: rehydration \u2192 normalization of Ht; polyglobulia vera (increased erythrocyte mass): primary: polyglobulia of Vaquez (PV) \u2192 JAK2 V617F mutation (95-97 % of cases) or JAK2 exon 12 \u2192 autonomous increase in RBCs (\u00b1 platelets \u00b1 leukocytes) \u2192 low or normal EPO + secondary: chronic hypoxia (COPD + sleep apnea + altitude) + cyanotic heart disease + high-affinity Hb + EPO-secreting tumor (hepatocarcinoma + renal cell carcinoma + cerebellar hemangioblastoma) \u2192 elevated EPO + increased erythrocyte mass \u2192 distinction: EPO assay + JAK2 V617F + isotopic erythrocyte mass (chromium-51 - reference method but not widely available) \u2192 in practice: if Ht >52 % in men or >48 % in women \u2192 investigation of polycythaemia + volume scintigraphy if necessary<\/li>\n <\/ul>\n\n <h2>Reduced, elevated hematocrit, and special situations<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Clinical situation<\/th><th>Interpretation and assessment<\/th><th>Conduct and follow-up<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Reduced hematocrit \u2014 diagnostic approach to anemia<br><small style=\"font-weight:400;color:#7a8fa0;\">VGM \u2014 reticulocytes \u2014 iron \u2014 B12 \u2014 folates \u2014 hemolysis<\/small><\/td>\n <td>A lowered hematocrit indicates anemia - the etiological diagnosis of which is based on systematic analysis of erythrocyte indices and complementary examinations; WHO definition of anemia: Hb <130 g\/L (Ht <39 %) in adult men + Hb <120 g\/L (Ht <36 %) in adult non-pregnant women + Hb <110 g\/L (Ht <33 %) in pregnant women (1st + 3rd trimester) + Hb <105 g\/L (Ht <32 %) in pregnant women (2nd trimester) + Hb <110 g\/L (Ht <33 %) in children aged 6 months to 5 years; morphological classification by VGM (first orientation tool): microcytic anemia (VGM 100 fL) : vitamin B12 deficiency (gastric atrophy + Biermer's disease + malabsorption + vegans) + folate deficiency (pregnancy + alcoholism + MTX + carbamazepine) + alcoholism (direct macrocytosis independent of deficiency) + hypothyroidism + drugs (hydroxyurea + zidovudine + stavudine) + myelodysplastic syndromes (MDS)<\/td>\n <td>1st-line workup for anemia (low Ht): Complete CBC with blood smear (erythrocyte morphology) + reticulocytes (correct for anemia \u2192 reticulocyte production index - RPN = reticulocytes (%) \u00d7 observed Ht \/ normal Ht \u00d7 1 \/ maturation factor \u2192 RPN >2: regenerative anemia \u2192 blood loss or hemolysis \u2192 RPN <2: aregenerative anemia \u2192 insufficient production) + serum ferritin (best marker of iron stores - lowered if deficient \u2192 specific if 100 \u00b5g\/L does not exclude deficiency if inflammatory state) + CRP (ferritin is an acute-phase reactant \u2192 if elevated + microcytic anemia \u2192 deficiency possible despite normal ferritin-high \u2192 soluble transferrin receptor sTfR assay) + vitamin B12 + serum or erythrocyte folate (if macrocytosis) + TSH (hypothyroidism) + renal work-up (creatinine + GFR - anemia of renal LDH + haptoglobin + indirect bilirubin + Coombs direct (DAT) if hemolysis suspected \u2192 elevated LDH + collapsed haptoglobin + elevated indirect bilirubin + reticulocytosis = hemolysis triad ; 2nd-line tests according to orientation: Hb electrophoresis (if microcytosis + numerous RBCs + Mediterranean\/Asian\/African origin \u2192 thalassemia or hemoglobinopathy) + G6PD erythrocyte assay (if hemolysis + triggering context) + bone marrow smear + myelogram (if pancytopenia + suspected MDS or aplasia) + digestive exploration if occult bleeding suspected (calprotectin + colonoscopy + FOGD)<\/td>\n <\/tr>\n <tr>\n <td>Low hematocrit - iron deficiency anemia<br><small style=\"font-weight:400;color:#7a8fa0;\">Ferritin \u2014 iron IV \u2014 occult bleeding \u2014 pregnancy<\/small><\/td>\n <td>Iron deficiency anemia is the most common cause of anemia and low hematocrit worldwide - leading cause in women of childbearing age and children; pathophysiology: iron is essential for hemoglobin synthesis (heme nucleus - protoporphyrin IX + Fe\u00b2\u207a) \u2192 iron deficiency \u2192 insufficient hemoglobin synthesis \u2192 microcytosis (low GMV) + hypochromia (low MHCC + low corpuscular Hb content) + deformed RBCs (elliptocytes + poikylocytes) \u2192 hypochromic microcytic anemia \u2192 stages of deficiency: stage 1 (depletion of reserves): low ferritin (<12 \u00b5g\/L - or <30 \u00b5g\/L if inflammatory state) + normal Hb + normal VGM + stage 2 (functional deficiency): low serum iron + low CST (<20 %) + high TIBC + hypochromic reticulocytes (CHr - Hb content of reticulocytes - <26 pg on Sysmex XE\/XN automaton) \u2192 Hb still normal but RBCs begin to be microcytic + stage 3 (constituted iron deficiency anemia): low Hb + VGM <80 fL + collapsed ferritin + abundant hypochromic microcytic RBCs; main causes of martial deficiency: in women of childbearing age: menorrhagia (number 1 cause in North America) + pregnancy (increased needs - maternal iron for fetus + placenta + expansion of erythrocyte mass) + digestive losses: gastrointestinal bleeding (peptic ulcer + colorectal cancer + angiodysplasia + Crohn's disease + aspirin + NSAIDs + anticoagulants) \u2192 main cause in adult men and postmenopausal women + malabsorption: celiac disease (duodenal villous atrophy \u2192 iron poorly absorbed in duodenum) + atrophic gastritis + post-bariatric surgery (gastric bypass \u2192 excludes duodenum = site of iron absorption) + inadequate intakes (strict veganism + restrictive diets + infants on unenriched cow's milk)<\/td>\n <td>Treatment of iron-deficiency anemia - practical approach: etiological treatment first: investigate and treat cause of bleeding (colonoscopy if >50 years or digestive symptoms + FOGD if ulcer suspected + gynecology if menorrhagia) \u2192 without etiological treatment: almost-certain relapse after discontinuation of supplementation; oral iron supplementation: ferrous iron (Fe\u00b2\u207a) better absorbed than ferric iron (Fe\u00b3\u207a) \u2192 ferrous sulfate 300 mg (= 60 mg elemental iron) \u00d7 2-3\/d or ferrous fumarate (Palafer) or ferrous gluconate (fewer side effects but less elemental iron) \u2192 take on an empty stomach (maximum absorption) \u2192 ascorbic acid (vitamin C) 200 mg simultaneously \u2192 improves absorption (reduces Fe\u00b3\u207a to Fe\u00b2\u207a) \u2192 avoid with PPIs + antacids + calcium + tea (tannins) + coffee (iron chelation) \u2192 side effects : nausea + constipation + black stools (benign) \u2192 if poorly tolerated: split dose + take with a meal (absorption reduced by 40 % but better tolerated) + recent data (Moretti 2015 - Blood): alternate-day administration optimal \u2192 reduces post-dose hepcidin \u2192 improves cumulative absorption vs daily dose \u2192 Tolkien 2015 trial (PLOS ONE): ferrous sulfate better tolerated in single morning dose vs split + monitoring: Ht + Hb + reticulocytes at 4 weeks (reticulocytosis = early sign of response at D7-10) \u2192 Hb normalization in 6-8 weeks \u2192 continue 3-6 months after normalization to replenish reserves (target ferritin >50 \u00b5g\/L); intravenous (IV) iron: indications: severe oral iron intolerance + malabsorption (celiac + bypass + Crohn's) + significant deficit to be corrected rapidly (pre-op + pregnancy + dialyzed CKD + heart failure) + agents: carboxymaltose iron (Ferinject - up to 1,000 mg per infusion \u00d7 15 min) + low-molecular-weight dextran iron (INFeD) + sucrose iron (Venofer) + superior efficacy to oral iron (Anker 2009 - NEJM - heart failure) + low allergic risk with modern preparations (<0.1 % severe reactions)<\/td>\n <\/tr>\n <tr>\n <td>High hematocrit - true polycythemia (Vaquez) and relative<br><small style=\"font-weight:400;color:#7a8fa0;\">JAK2 - EPO - phlebotomy - hydroxyurea - thrombosis<\/small><\/td>\n <td>An elevated hematocrit above normal values makes it necessary to distinguish true polyglobulia (increased erythrocyte mass) from pseudopolyglobulia (hemoconcentration); thresholds for investigation (WHO 2016 criteria): Ht >49 % in men or >48 % in women \u2192 polycythemia workup \u2192 complete CBC + EPO + JAK2 V617F; Vaquez polycythemia (PV) - myeloproliferative neoplasm: WHO 2016 diagnostic criteria: major criteria: (1) Hb >165 g\/L in men or >160 g\/L in women (or erythrocyte mass >25 % above normal value) + (2) bone-medullary biopsy: panmyeloid hypercellularity (erythroid + granulocytic + megakaryocytic) + megakaryocyte pleomorphism + (3) JAK2 V617F or JAK2 exon 12 mutation \u2192 minor criterion: subnormal or low serum EPO \u2192 PV diagnosis if: 3 major criteria or 2 major criteria + 1 minor \u2192 JAK2 V617F positive in 95-97 % of PVs \u2192 detection by allele-specific PCR or NGS sequencing \u2192 JAK2 V617F allelic load correlates with severity (thrombosis + progression to myelofibrosis); complications of Vaquez polycythaemia: thromboses (major complication): Stroke + MI + deep vein thrombosis + pulmonary embolism + thrombosis of suprahepatic veins (Budd-Chiari syndrome - classic presentations of PV) + portal vein thrombosis \u2192 high hematocrit \u2192 hyperviscosity \u2192 slowed blood flow \u2192 thrombosis \u2192 thrombotic risk correlates with Ht (goal: maintain Ht <45 % in men and <42 % in women) + aquagenic pruritus (contact with water \u2192 release of histamine by basophils) + erythromelalgia (burning and redness of extremities relieved by aspirin) + transformation: post-PV myelofibrosis (15 % at 15 years) + acute myeloid leukemia (AML) (<5 %)<\/td>\n <td>Treatment of Vaquez polyglobulia: objectives: maintain Ht <45 % (male) or <42 % (female) to reduce thrombotic risk \u2192 based on CYTO-PV trial (Marchioli 2013 - NEJM): Ht 60 years + history of thrombosis + thrombocytosis >1,500 \u00d7 10\u2079\/L + poor bleeding tolerance + dose: 500-2,000 mg\/d PO \u2192 monitor CBC every 4-8 weeks \u2192 goal: normalized RBCs + platelets + leukocytes >3 \u00d7 10\u2079\/L + ruxolitinib (Jakafi - JAK1\/2 inhibitor): 2nd line if hydroxyurea insufficient or poorly tolerated \u2192 approved in Canada for refractory PV \u2192 superior control of Ht and symptoms (pruritus + splenomegaly) - RESPONSE trial (Vannucchi 2015 - NEJM) + pegylated interferon alpha-2a: option in women of childbearing age (no documented teratogenicity + anticlonal activity) + hematology opinion mandatory for any confirmed PV<\/td>\n <\/tr>\n <tr>\n <td>Hematocrit and anemia in specific situations<br><small style=\"font-weight:400;color:#7a8fa0;\">IRC \u2014 pregnancy \u2014 sickle cell disease \u2014 sport \u2014 transfusion<\/small><\/td>\n <td>Hematocrit is interpreted differently depending on the clinical context - several situations deserve special attention; anemia of chronic renal failure (CKD): main mechanism: deficiency in erythropoietin (EPO) production by renal peritubular cells (EPO cells) \u2192 normocytic normochromic + aregenerative anemia (low reticulocytes) + Ht often between 25 and 35 % \u2192 aggravating factors: martial deficiency (dialysis losses + malabsorption) + chronic inflammation + shortened RBC lifespan (uremia) + severe hyperparathyroidism (bone marrow invasion by fibrosis) \u2192 treatment: erythropoiesis-stimulating agents (ESAs): epoetin alfa (Eprex) + darbepoetin alfa (Aranesp) + methoxy-polyethylene glycol-epoetin beta (Mircera) \u2192 KDIGO 2012 indication: initiate if Hb 200 \u00b5g\/L + CST >20 %) + Hb target under ESA: 100-115 g\/L (do not aim for Hb >130 g\/L \u2192 increased cardiovascular risk - TREAT 2009 NEJM trial + CHOIR 2006 NEJM) + reimbursement of ESAs in Quebec via RAMQ for dialyzed and pre-dialyzed CKD according to registration criteria + patient blood management (PBM): reduce recourse to transfusion \u2192 ESA + IV iron (Ferinject) + peri-operative management; hemolytic anemia - recognize the picture: reticulocytosis (RPN >2) + elevated LDH + collapsed haptoglobin + elevated indirect bilirubin + smear: spherocytes (AHAI) + sickle cells + schizocytes (MAT) + sickle cell disease : baseline Ht 20-30 % (severe chronic anemia due to sickle-shaped RBC hemolysis) + vaso-occlusive crises \u2192 accelerated destruction of RBCs \u2192 sudden drop in Ht \u2192 urgent transfusion if >20 % drop from baseline + baseline Ht monitoring essential for sickle cell patient.<\/td>\n <td>Hematocrit and sport - sports anemia and doping: \u00absports anemia\u00bb (pseudoanemia): endurance athletes (marathon + cycling + triathlon) \u2192 plasma volume expansion disproportionate to erythrocyte mass increase \u2192 lowered Ht (often 36-40 % in well-trained male athletes) + normal-low Hb \u2192 no true anemia \u2192 no treatment \u2192 exclude martial deficiency (ferritin) \u2192 adapt nutritional requirements (iron + B12 + folates) + doping with EPO (exogenous erythropoietin): illicit administration of recombinant EPO \u2192 increased Ht \u2192 improved O\u2082 transport \u2192 enhanced performance \u2192 major thrombotic risk (several documented deaths in professional cyclists - 1990s) \u2192 anti-doping control: biological passport test (ABP - Athlete Biological Passport) \u2192 longitudinal variations in Ht + reticulocytes \u2192 detects profiles suggestive of doping even without direct EPO testing; transfusion thresholds - when to transfuse? restrictive transfusion thresholds (AABB 2016 + TRICC 1999): stable patient without symptoms: transfuse only if Hb <70 g\/L (Ht <21 %) + patient with active coronary artery disease (ACS): threshold <80 g\/L (Ht <24 %) + post-operative orthopedic patient with symptoms: threshold <80 g\/L + post-cardiac surgery: threshold <75-80 g\/L \u2192 transfusion decision should not be based on Ht figure alone - always integrate symptoms (asthenia + dyspnea + angina + hypotension) + comorbidities + fall kinetics<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>The hematocrit should always be interpreted in conjunction with the patient's hydration status:<\/strong> A hematocrit of 50% % in a dehydrated patient does not mean the same thing as in a normovolemic patient. Similarly, a hematocrit of 30% % in a pregnant woman in her second trimester can be entirely physiological. The correct interpretation of hematocrit integrates MCV, MCHC, reticulocytes, clinical context, and volume status\u2014never in isolation.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical assessment<\/div>\n <p><strong>Hematocrit <20 % (Hb <65\u201370 g\/L) + dyspnea at rest + tachycardia + hypotension + angina or altered consciousness<\/strong> \u2192 Severe symptomatic anemia \u2192 indication for urgent transfusion \u2192 O- red blood cell units if blood type is unavailable \u2192 CBC + reticulocytes + urgent etiological workup.<\/p>\n <p><strong>Sudden drop in hematocrit + abdominal pain + hemodynamically unstable (tachycardia + hypotension) or rectorrhagia + abundant melena<\/strong> \u2192 Acute digestive bleeding \u2192 CBC + blood type + RPR + coagulation and emergency workup + endoscopy within 24 hours \u2192 transfusion if Hb <70 g\/L or hemodynamic instability.<\/p>\n <p><strong>Hematocrit >55-60% % (very high Hct) + headache + blurred vision + facial redness + recent thrombosis (stroke + DVT) or aquagenic pruritus<\/strong> \u2192 probable polycythemia vera \u2192 JAK2 V617F + serum EPO urgently \u2192 immediate therapeutic phlebotomy (500 mL) if Hct >60% % \u2192 urgent hematology consult.<\/p>\n <p><strong>Sudden drop in hemoglobin in a sickle cell patient with fever, intense bone pain, and acute splenomegaly.<\/strong> Acute splenic sequestration (especially in children) or aplastic crisis (parvovirus B19) \u2192 pediatric emergency \u2192 urgent transfusion if Ht <20 % baseline + immediate hospitalization.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>The doctors at Clinique Omicron prescribe and interpret complete blood counts, including hematocrit, as part of general health check-ups, chronic disease monitoring, prenatal assessments, and evaluations for symptoms of anemia or polycythemia. The initial management of iron-deficiency anemia \u2013 oral supplementation or referral for intravenous iron \u2013 as well as the monitoring of anemia in kidney failure can be coordinated at one of our service points in Quebec or via teleconsultation. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and is not a substitute for medical or hematological advice. Any abnormality in hematocrit should be evaluated in its full clinical context before diagnosis or treatment is initiated.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>H\u00e9matocrite (Ht) : valeurs normales, causes d’anomalies et interpr\u00e9tation | Clinique Omicron H\u00e9matologie & M\u00e9decine de famille & M\u00e9decine interne H\u00e9matocrite (Ht) L’h\u00e9matocrite (Ht), aussi appel\u00e9 volume globulaire (VG) ou packed cell volume (PCV), exprime la fraction volumique occup\u00e9e par les globules rouges (\u00e9rythrocytes) dans un volume donn\u00e9 de sang total. Il est exprim\u00e9 en… <a href=\"https:\/\/cliniqueomicron.ca\/en\/hematocrite-ht\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">H\u00e9matocrite (Ht) : valeurs normales, causes d’anomalies et interpr\u00e9tation | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"H\u00e9matocrite (Ht) : valeurs | Brossard | Clinique Omicron","_metasync_otto_description":"L'h\u00e9matocrite mesure la proportion de globules rouges dans le sang. 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\n\t\t\t\t\t\n\n\n\n\nHematocrit (Ht): Normal Values, Causes of Abnormalities, and Interpretation | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Hematocrit measures the proportion of red blood cells in the blood. Low hematocrit (anemia), high hematocrit (polycythemia): interpretation, causes, and management in Quebec.\">\n<meta name=\"keywords\" content=\"h\u00e9matocrite valeurs normales, h\u00e9matocrite bas an\u00e9mie, h\u00e9matocrite \u00e9lev\u00e9 polyglobulie, h\u00e9matocrite interpr\u00e9tation, h\u00e9matocrite grossesse, h\u00e9matocrite d\u00e9shydratation, h\u00e9matocrite NFS Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Hematology & Family Medicine & Internal Medicine<\/span>\n <h1>Hematocrit (Hct)<\/h1>\n\n <div class=\"co-intro\">\n Hematocrit (Ht), also known as packed cell volume (PCV), expresses the volume fraction occupied by red blood cells (erythrocytes) in a given volume of whole blood. It is expressed as a percentage (%) or as a decimal fraction (L\/L). Measured on modern hematology machines by indirect calculation (Ht = RBC \u00d7 VGM \/ 10), or historically by capillary centrifugation (microhematocrit), it is one of the most widely used blood count parameters in clinical practice. Normal adult hematocrit values are 41 to 53 % in men and 36 to 46 % in women, with significant physiological variations depending on age (infant: 33-55 %, newborn: up to 65 %), pregnancy (physiological hemodilution \u2192 Ht may drop to 32-34 %) and altitude (hypoxia-adaptation polycythemia). Hematocrit is closely related to hemoglobin (Hb) by the approximate relationship: Hb (g\/dL) \u2248 Ht (%) \/ 3. A low hematocrit indicates anemia (reduced erythrocyte mass or plasma dilution), while a high hematocrit suggests polycythaemia (true or relative due to hemoconcentration). Interpretation of the hematocrit is always contextual - it is integrated into the complete blood count with the mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), reticulocytosis and erythrocyte indices to guide the etiological diagnosis.\n <\/div>\n\n <h2>Physiology, Reference Values, and Relationships with Other Erythrocytic Parameters<\/h2>\n <ul class=\"co-list\">\n <li><strong>Definition, measurement methods, and calculation:<\/strong> definition: hematocrit represents the ratio of red blood cell volume to total blood volume \u2192 Ht = RBC volume \/ total blood volume \u00d7 100 \u2192 in practice on an automated system: Ht (%) = RBC (\u00d710\u00b9\u00b2\/L) \u00d7 GMV (fL) \/ 10 \u2192 this formula gives the calculated hematocrit (slightly higher than measured by centrifugation due to residual plasma trapped between RBCs - \u00abtrapped plasma\u00bb - approximately 1-3 % difference); historical method (microhematocrit): capillary or venous blood in a heparinized capillary tube \u2192 centrifugation 10,000 g \u00d7 5 min \u2192 direct reading of the height of the RBC column in relation to the total volume \u2192 reference method (Gold Standard) for detecting certain morphological abnormalities in RBCs (visible buffy coat) \u2192 microhematocrit method still used in pediatrics + in emergency (arterial blood gases \u2192 co-oxymeter); hematology automata (Sysmex XN + Beckman-Coulter DxH): hematocrit is calculated from RBC counting by electrical impedance (Coulter method) and VGM measurement \u2192 more reproducible result than microhematocrit + available in seconds + hematocrit-hemoglobin-VGM relationship: fundamental formulas: Ht \u2248 Hb \u00d7 3 (rule of thirds - clinical approximation) + VGM = Ht \/ GR \u00d7 10 (fL) + CCMH = Hb \/ Ht \u00d7 100 (g\/dL) + TCMH = Hb \/ GR \u00d7 10 (pg) \u2192 example: Ht 36 % + GR 3.8 \u00d7 10\u00b9\u00b2\/L + Hb 12 g\/dL \u2192 VGM = 36 \/ 3.8 \u00d7 10 = 94.7 fL (normocytic) + CCMH = 12 \/ 0.36 = 33.3 g\/dL (normochromic)<\/li>\n <li><strong>Normal values by age, sex, and physiological conditions:<\/strong> adult reference values (Canadian laboratories - venous plasma - calibrated automatons): adult male (18-65 years): 41-53 % + adult female (18-65 years): 36-46 % \u2192 male-female difference: due to androgens (testosterone stimulates erythropoiesis \u2192 GR + Hb + Ht higher in men) + menstrual iron loss (Ht lower in women of childbearing age); age variations: newborn (birth): 44-64 % \u2192 physiological polyglobulia (intense fetal erythropoiesis + predominant fetal Hb HbF) \u2192 physiological neonatal hemolysis \u2192 drops to 30-40 % at 2-3 months (physiological nadir) + infant 6 months-2 years: 33-40 % + child 2-12 years: 35-45 % + adolescent: gradually towards adult values (M\/F divergence at puberty) + elderly (>70 years): slight physiological decline accepted (Ht >36 % man + >33 % woman) - NB: anemia should not be attributed to aging alone without investigation + altitude: hypoxia \u2192 increased EPO \u2192 stimulation of erythropoiesis \u2192 higher Ht \u2192 at 3,000 m: Ht can reach 55-60 % + at 4,500 m (Himalayas + Andes): 60-65 % + pregnancy: physiological hemodilution (increase in plasma volume of 40-50 % + lesser increase in erythrocyte mass of 20-30 %) \u2192 drop in Ht to 32-34 % in the 2nd-3rd trimester \u2192 non-pathological physiological anemia \u2192 WHO threshold for anemia in pregnancy: Hb <110 g\/L (Ht <33 %) in 1st and 3rd trimester + Hb <105 g\/L (Ht <32 %) in 2nd trimester + smoking: slight rise in Ht (smoking polyglobulia - carboxyhemoglobin \u2192 relative tissue hypoxia \u2192 EPO stimulation) + intense, chronic physical training (endurance athletes): proportionally greater increase in plasma volume \u2192 \u00absportsman's anemia\u00bb (lowered Ht despite normal erythrocyte mass)<\/li>\n <li><strong>Hematocrit and blood volume - distinction between true polycythemia and relative polycythemia:<\/strong> fundamental concept: hematocrit measures a fraction (RBC \/ total blood volume) \u2192 may be elevated either because total erythrocyte mass is increased (polyglobulia vera) or because plasma volume is reduced (relative polyglobulia by hemoconcentration) \u2192 essential distinction because treatment is radically different; relative polyglobulia (hemoconcentration) : causes: dehydration (gastroenteritis + heat + excessive sweating + vomiting + profuse diarrhea) + Gaisbock syndrome (relative polyglobulia of stressed hypertensive heavy smoker + no increase in erythrocyte mass) + diuretics + extensive burns (plasma loss) \u2192 high Ht + normal or reduced total blood volume + normal reticulocytes + normal EPO \u2192 treatment: rehydration \u2192 normalization of Ht; polyglobulia vera (increased erythrocyte mass): primary: polyglobulia of Vaquez (PV) \u2192 JAK2 V617F mutation (95-97 % of cases) or JAK2 exon 12 \u2192 autonomous increase in RBCs (\u00b1 platelets \u00b1 leukocytes) \u2192 low or normal EPO + secondary: chronic hypoxia (COPD + sleep apnea + altitude) + cyanotic heart disease + high-affinity Hb + EPO-secreting tumor (hepatocarcinoma + renal cell carcinoma + cerebellar hemangioblastoma) \u2192 elevated EPO + increased erythrocyte mass \u2192 distinction: EPO assay + JAK2 V617F + isotopic erythrocyte mass (chromium-51 - reference method but not widely available) \u2192 in practice: if Ht >52 % in men or >48 % in women \u2192 investigation of polycythaemia + volume scintigraphy if necessary<\/li>\n <\/ul>\n\n <h2>Reduced, elevated hematocrit, and special situations<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:200px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Clinical situation<\/th><th>Interpretation and assessment<\/th><th>Conduct and follow-up<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Reduced hematocrit \u2014 diagnostic approach to anemia<br><small style=\"font-weight:400;color:#7a8fa0;\">VGM \u2014 reticulocytes \u2014 iron \u2014 B12 \u2014 folates \u2014 hemolysis<\/small><\/td>\n <td>A lowered hematocrit indicates anemia - the etiological diagnosis of which is based on systematic analysis of erythrocyte indices and complementary examinations; WHO definition of anemia: Hb <130 g\/L (Ht <39 %) in adult men + Hb <120 g\/L (Ht <36 %) in adult non-pregnant women + Hb <110 g\/L (Ht <33 %) in pregnant women (1st + 3rd trimester) + Hb <105 g\/L (Ht <32 %) in pregnant women (2nd trimester) + Hb <110 g\/L (Ht <33 %) in children aged 6 months to 5 years; morphological classification by VGM (first orientation tool): microcytic anemia (VGM 100 fL) : vitamin B12 deficiency (gastric atrophy + Biermer's disease + malabsorption + vegans) + folate deficiency (pregnancy + alcoholism + MTX + carbamazepine) + alcoholism (direct macrocytosis independent of deficiency) + hypothyroidism + drugs (hydroxyurea + zidovudine + stavudine) + myelodysplastic syndromes (MDS)<\/td>\n <td>1st-line workup for anemia (low Ht): Complete CBC with blood smear (erythrocyte morphology) + reticulocytes (correct for anemia \u2192 reticulocyte production index - RPN = reticulocytes (%) \u00d7 observed Ht \/ normal Ht \u00d7 1 \/ maturation factor \u2192 RPN >2: regenerative anemia \u2192 blood loss or hemolysis \u2192 RPN <2: aregenerative anemia \u2192 insufficient production) + serum ferritin (best marker of iron stores - lowered if deficient \u2192 specific if 100 \u00b5g\/L does not exclude deficiency if inflammatory state) + CRP (ferritin is an acute-phase reactant \u2192 if elevated + microcytic anemia \u2192 deficiency possible despite normal ferritin-high \u2192 soluble transferrin receptor sTfR assay) + vitamin B12 + serum or erythrocyte folate (if macrocytosis) + TSH (hypothyroidism) + renal work-up (creatinine + GFR - anemia of renal LDH + haptoglobin + indirect bilirubin + Coombs direct (DAT) if hemolysis suspected \u2192 elevated LDH + collapsed haptoglobin + elevated indirect bilirubin + reticulocytosis = hemolysis triad ; 2nd-line tests according to orientation: Hb electrophoresis (if microcytosis + numerous RBCs + Mediterranean\/Asian\/African origin \u2192 thalassemia or hemoglobinopathy) + G6PD erythrocyte assay (if hemolysis + triggering context) + bone marrow smear + myelogram (if pancytopenia + suspected MDS or aplasia) + digestive exploration if occult bleeding suspected (calprotectin + colonoscopy + FOGD)<\/td>\n <\/tr>\n <tr>\n <td>Low hematocrit - iron deficiency anemia<br><small style=\"font-weight:400;color:#7a8fa0;\">Ferritin \u2014 iron IV \u2014 occult bleeding \u2014 pregnancy<\/small><\/td>\n <td>Iron deficiency anemia is the most common cause of anemia and low hematocrit worldwide - leading cause in women of childbearing age and children; pathophysiology: iron is essential for hemoglobin synthesis (heme nucleus - protoporphyrin IX + Fe\u00b2\u207a) \u2192 iron deficiency \u2192 insufficient hemoglobin synthesis \u2192 microcytosis (low GMV) + hypochromia (low MHCC + low corpuscular Hb content) + deformed RBCs (elliptocytes + poikylocytes) \u2192 hypochromic microcytic anemia \u2192 stages of deficiency: stage 1 (depletion of reserves): low ferritin (<12 \u00b5g\/L - or <30 \u00b5g\/L if inflammatory state) + normal Hb + normal VGM + stage 2 (functional deficiency): low serum iron + low CST (<20 %) + high TIBC + hypochromic reticulocytes (CHr - Hb content of reticulocytes - <26 pg on Sysmex XE\/XN automaton) \u2192 Hb still normal but RBCs begin to be microcytic + stage 3 (constituted iron deficiency anemia): low Hb + VGM <80 fL + collapsed ferritin + abundant hypochromic microcytic RBCs; main causes of martial deficiency: in women of childbearing age: menorrhagia (number 1 cause in North America) + pregnancy (increased needs - maternal iron for fetus + placenta + expansion of erythrocyte mass) + digestive losses: gastrointestinal bleeding (peptic ulcer + colorectal cancer + angiodysplasia + Crohn's disease + aspirin + NSAIDs + anticoagulants) \u2192 main cause in adult men and postmenopausal women + malabsorption: celiac disease (duodenal villous atrophy \u2192 iron poorly absorbed in duodenum) + atrophic gastritis + post-bariatric surgery (gastric bypass \u2192 excludes duodenum = site of iron absorption) + inadequate intakes (strict veganism + restrictive diets + infants on unenriched cow's milk)<\/td>\n <td>Treatment of iron-deficiency anemia - practical approach: etiological treatment first: investigate and treat cause of bleeding (colonoscopy if >50 years or digestive symptoms + FOGD if ulcer suspected + gynecology if menorrhagia) \u2192 without etiological treatment: almost-certain relapse after discontinuation of supplementation; oral iron supplementation: ferrous iron (Fe\u00b2\u207a) better absorbed than ferric iron (Fe\u00b3\u207a) \u2192 ferrous sulfate 300 mg (= 60 mg elemental iron) \u00d7 2-3\/d or ferrous fumarate (Palafer) or ferrous gluconate (fewer side effects but less elemental iron) \u2192 take on an empty stomach (maximum absorption) \u2192 ascorbic acid (vitamin C) 200 mg simultaneously \u2192 improves absorption (reduces Fe\u00b3\u207a to Fe\u00b2\u207a) \u2192 avoid with PPIs + antacids + calcium + tea (tannins) + coffee (iron chelation) \u2192 side effects : nausea + constipation + black stools (benign) \u2192 if poorly tolerated: split dose + take with a meal (absorption reduced by 40 % but better tolerated) + recent data (Moretti 2015 - Blood): alternate-day administration optimal \u2192 reduces post-dose hepcidin \u2192 improves cumulative absorption vs daily dose \u2192 Tolkien 2015 trial (PLOS ONE): ferrous sulfate better tolerated in single morning dose vs split + monitoring: Ht + Hb + reticulocytes at 4 weeks (reticulocytosis = early sign of response at D7-10) \u2192 Hb normalization in 6-8 weeks \u2192 continue 3-6 months after normalization to replenish reserves (target ferritin >50 \u00b5g\/L); intravenous (IV) iron: indications: severe oral iron intolerance + malabsorption (celiac + bypass + Crohn's) + significant deficit to be corrected rapidly (pre-op + pregnancy + dialyzed CKD + heart failure) + agents: carboxymaltose iron (Ferinject - up to 1,000 mg per infusion \u00d7 15 min) + low-molecular-weight dextran iron (INFeD) + sucrose iron (Venofer) + superior efficacy to oral iron (Anker 2009 - NEJM - heart failure) + low allergic risk with modern preparations (<0.1 % severe reactions)<\/td>\n <\/tr>\n <tr>\n <td>High hematocrit - true polycythemia (Vaquez) and relative<br><small style=\"font-weight:400;color:#7a8fa0;\">JAK2 - EPO - phlebotomy - hydroxyurea - thrombosis<\/small><\/td>\n <td>An elevated hematocrit above normal values makes it necessary to distinguish true polyglobulia (increased erythrocyte mass) from pseudopolyglobulia (hemoconcentration); thresholds for investigation (WHO 2016 criteria): Ht >49 % in men or >48 % in women \u2192 polycythemia workup \u2192 complete CBC + EPO + JAK2 V617F; Vaquez polycythemia (PV) - myeloproliferative neoplasm: WHO 2016 diagnostic criteria: major criteria: (1) Hb >165 g\/L in men or >160 g\/L in women (or erythrocyte mass >25 % above normal value) + (2) bone-medullary biopsy: panmyeloid hypercellularity (erythroid + granulocytic + megakaryocytic) + megakaryocyte pleomorphism + (3) JAK2 V617F or JAK2 exon 12 mutation \u2192 minor criterion: subnormal or low serum EPO \u2192 PV diagnosis if: 3 major criteria or 2 major criteria + 1 minor \u2192 JAK2 V617F positive in 95-97 % of PVs \u2192 detection by allele-specific PCR or NGS sequencing \u2192 JAK2 V617F allelic load correlates with severity (thrombosis + progression to myelofibrosis); complications of Vaquez polycythaemia: thromboses (major complication): Stroke + MI + deep vein thrombosis + pulmonary embolism + thrombosis of suprahepatic veins (Budd-Chiari syndrome - classic presentations of PV) + portal vein thrombosis \u2192 high hematocrit \u2192 hyperviscosity \u2192 slowed blood flow \u2192 thrombosis \u2192 thrombotic risk correlates with Ht (goal: maintain Ht <45 % in men and <42 % in women) + aquagenic pruritus (contact with water \u2192 release of histamine by basophils) + erythromelalgia (burning and redness of extremities relieved by aspirin) + transformation: post-PV myelofibrosis (15 % at 15 years) + acute myeloid leukemia (AML) (<5 %)<\/td>\n <td>Treatment of Vaquez polyglobulia: objectives: maintain Ht <45 % (male) or <42 % (female) to reduce thrombotic risk \u2192 based on CYTO-PV trial (Marchioli 2013 - NEJM): Ht 60 years + history of thrombosis + thrombocytosis >1,500 \u00d7 10\u2079\/L + poor bleeding tolerance + dose: 500-2,000 mg\/d PO \u2192 monitor CBC every 4-8 weeks \u2192 goal: normalized RBCs + platelets + leukocytes >3 \u00d7 10\u2079\/L + ruxolitinib (Jakafi - JAK1\/2 inhibitor): 2nd line if hydroxyurea insufficient or poorly tolerated \u2192 approved in Canada for refractory PV \u2192 superior control of Ht and symptoms (pruritus + splenomegaly) - RESPONSE trial (Vannucchi 2015 - NEJM) + pegylated interferon alpha-2a: option in women of childbearing age (no documented teratogenicity + anticlonal activity) + hematology opinion mandatory for any confirmed PV<\/td>\n <\/tr>\n <tr>\n <td>Hematocrit and anemia in specific situations<br><small style=\"font-weight:400;color:#7a8fa0;\">IRC \u2014 pregnancy \u2014 sickle cell disease \u2014 sport \u2014 transfusion<\/small><\/td>\n <td>Hematocrit is interpreted differently depending on the clinical context - several situations deserve special attention; anemia of chronic renal failure (CKD): main mechanism: deficiency in erythropoietin (EPO) production by renal peritubular cells (EPO cells) \u2192 normocytic normochromic + aregenerative anemia (low reticulocytes) + Ht often between 25 and 35 % \u2192 aggravating factors: martial deficiency (dialysis losses + malabsorption) + chronic inflammation + shortened RBC lifespan (uremia) + severe hyperparathyroidism (bone marrow invasion by fibrosis) \u2192 treatment: erythropoiesis-stimulating agents (ESAs): epoetin alfa (Eprex) + darbepoetin alfa (Aranesp) + methoxy-polyethylene glycol-epoetin beta (Mircera) \u2192 KDIGO 2012 indication: initiate if Hb 200 \u00b5g\/L + CST >20 %) + Hb target under ESA: 100-115 g\/L (do not aim for Hb >130 g\/L \u2192 increased cardiovascular risk - TREAT 2009 NEJM trial + CHOIR 2006 NEJM) + reimbursement of ESAs in Quebec via RAMQ for dialyzed and pre-dialyzed CKD according to registration criteria + patient blood management (PBM): reduce recourse to transfusion \u2192 ESA + IV iron (Ferinject) + peri-operative management; hemolytic anemia - recognize the picture: reticulocytosis (RPN >2) + elevated LDH + collapsed haptoglobin + elevated indirect bilirubin + smear: spherocytes (AHAI) + sickle cells + schizocytes (MAT) + sickle cell disease : baseline Ht 20-30 % (severe chronic anemia due to sickle-shaped RBC hemolysis) + vaso-occlusive crises \u2192 accelerated destruction of RBCs \u2192 sudden drop in Ht \u2192 urgent transfusion if >20 % drop from baseline + baseline Ht monitoring essential for sickle cell patient.<\/td>\n <td>Hematocrit and sport - sports anemia and doping: \u00absports anemia\u00bb (pseudoanemia): endurance athletes (marathon + cycling + triathlon) \u2192 plasma volume expansion disproportionate to erythrocyte mass increase \u2192 lowered Ht (often 36-40 % in well-trained male athletes) + normal-low Hb \u2192 no true anemia \u2192 no treatment \u2192 exclude martial deficiency (ferritin) \u2192 adapt nutritional requirements (iron + B12 + folates) + doping with EPO (exogenous erythropoietin): illicit administration of recombinant EPO \u2192 increased Ht \u2192 improved O\u2082 transport \u2192 enhanced performance \u2192 major thrombotic risk (several documented deaths in professional cyclists - 1990s) \u2192 anti-doping control: biological passport test (ABP - Athlete Biological Passport) \u2192 longitudinal variations in Ht + reticulocytes \u2192 detects profiles suggestive of doping even without direct EPO testing; transfusion thresholds - when to transfuse? restrictive transfusion thresholds (AABB 2016 + TRICC 1999): stable patient without symptoms: transfuse only if Hb <70 g\/L (Ht <21 %) + patient with active coronary artery disease (ACS): threshold <80 g\/L (Ht <24 %) + post-operative orthopedic patient with symptoms: threshold <80 g\/L + post-cardiac surgery: threshold <75-80 g\/L \u2192 transfusion decision should not be based on Ht figure alone - always integrate symptoms (asthenia + dyspnea + angina + hypotension) + comorbidities + fall kinetics<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span><strong>The hematocrit should always be interpreted in conjunction with the patient's hydration status:<\/strong> A hematocrit of 50% % in a dehydrated patient does not mean the same thing as in a normovolemic patient. Similarly, a hematocrit of 30% % in a pregnant woman in her second trimester can be entirely physiological. The correct interpretation of hematocrit integrates MCV, MCHC, reticulocytes, clinical context, and volume status\u2014never in isolation.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Situations requiring urgent medical assessment<\/div>\n <p><strong>Hematocrit <20 % (Hb <65\u201370 g\/L) + dyspnea at rest + tachycardia + hypotension + angina or altered consciousness<\/strong> \u2192 Severe symptomatic anemia \u2192 indication for urgent transfusion \u2192 O- red blood cell units if blood type is unavailable \u2192 CBC + reticulocytes + urgent etiological workup.<\/p>\n <p><strong>Sudden drop in hematocrit + abdominal pain + hemodynamically unstable (tachycardia + hypotension) or rectorrhagia + abundant melena<\/strong> \u2192 Acute digestive bleeding \u2192 CBC + blood type + RPR + coagulation and emergency workup + endoscopy within 24 hours \u2192 transfusion if Hb <70 g\/L or hemodynamic instability.<\/p>\n <p><strong>Hematocrit >55-60% % (very high Hct) + headache + blurred vision + facial redness + recent thrombosis (stroke + DVT) or aquagenic pruritus<\/strong> \u2192 probable polycythemia vera \u2192 JAK2 V617F + serum EPO urgently \u2192 immediate therapeutic phlebotomy (500 mL) if Hct >60% % \u2192 urgent hematology consult.<\/p>\n <p><strong>Sudden drop in hemoglobin in a sickle cell patient with fever, intense bone pain, and acute splenomegaly.<\/strong> Acute splenic sequestration (especially in children) or aplastic crisis (parvovirus B19) \u2192 pediatric emergency \u2192 urgent transfusion if Ht <20 % baseline + immediate hospitalization.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>The doctors at Clinique Omicron prescribe and interpret complete blood counts, including hematocrit, as part of general health check-ups, chronic disease monitoring, prenatal assessments, and evaluations for symptoms of anemia or polycythemia. The initial management of iron-deficiency anemia \u2013 oral supplementation or referral for intravenous iron \u2013 as well as the monitoring of anemia in kidney failure can be coordinated at one of our service points in Quebec or via teleconsultation. To make an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and is not a substitute for medical or hematological advice. Any abnormality in hematocrit should be evaluated in its full clinical context before diagnosis or treatment is initiated.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>H\u00e9matocrite (Ht) : valeurs normales, causes d’anomalies et interpr\u00e9tation | Clinique Omicron H\u00e9matologie & M\u00e9decine de famille & M\u00e9decine interne H\u00e9matocrite (Ht) L’h\u00e9matocrite (Ht), aussi appel\u00e9 volume globulaire (VG) ou packed cell volume (PCV), exprime la fraction volumique occup\u00e9e par les globules rouges (\u00e9rythrocytes) dans un volume donn\u00e9 de sang total. Il est exprim\u00e9 en… <a href=\"https:\/\/cliniqueomicron.ca\/en\/hematocrite-ht\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">H\u00e9matocrite (Ht) : valeurs normales, causes d’anomalies et interpr\u00e9tation | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"H\u00e9matocrite (Ht) : valeurs | Brossard | Clinique Omicron","_metasync_otto_description":"L'h\u00e9matocrite mesure la proportion de globules rouges dans le sang. 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