Higher than normal hemoglobin levels can be seen in people living at high altitudes and in people who smoke. Dehydration produces a falsely high hemoglobin measurement that disappears when proper fluid balance is restored.

Some other infrequent causes are high hemoglobin levels are:

• advanced lung disease (for example, emphysema);
• certain tumors;
• a disorder of the bone marrow known as polycythemia rubra vera, and;
• abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes (increasing the amount of oxygen available to the body by chemically raising the production of red blood cells).

Sickle cell disease is a genetic condition in which the quality of hemoglobin is defective. This condition can cause abnormal hemoglobin that can result in abnormally-shaped (sickled) red blood cells (see illustration). These abnormal red blood cells cannot easily pass through small blood vessels leading to inadequate oxygen for the tissues of the body.

Sickle cells also have a shorter life span than normal red blood cells (10 to 20 days compared to 120 days). This rapid turnover may result in inadequate time to replace the red blood cells and may result in anemia.

In sickle cell anemia, one defective hemoglobin gene is inherited from each parent. If only one gene is inherited from one parent, then the condition is milder and referred to as sickle cell trait.

Symptoms of sickle cell anemia vary depending on its severity. Patients with sickle cell trait may experience mild, if any, symptoms at all. In sickle cell disease, symptoms are more significant, especially in episodes of acute crisis. These symptoms can include:

• generalized body aches and pain,
• chest pain,
• bone pain,
• shortness of breath,
• ulceration of skin,
• fatigue,
• strokes,
• blindness, and
• delayed growth and puberty.

Thalassemia is a group of hereditary conditions with quantitative hemoglobin deficiency. The body’s failure to make globulin molecules will lead to a compensatory mechanism to make other less compatible globulin molecules. The different types of thalassemia are defined based on what type of globulin molecule is deficient. The severity of these conditions depends on the type of deficient globulin chain, the number of deficient globulins, and the severity of the underproduction. Mild disease may only present as mild anemia whereas severe deficiency may not be compatible with life.

There are a number of ways to increase hemoglobin levels. In general, low hemoglobin levels that need to be increased are caused by three circumstances: decreased red blood cell production (for example, altered bone marrow hemoglobin production, iron deficiency), increased red blood cell destruction (for example, liver disease), and by blood loss (for example, trauma from a gunshot or knife wound). Addressing these underlying causes of low hemoglobin levels initially determines what method to use to increase hemoglobin levels.

Methods to increase hemoglobin levels are varied and their use depends on the underlying problems. Some of the ways to increase hemoglobin include:

• transfusing red blood cells
• receiving erythropoietin (a hormone used to stimulate red blood cell production in individuals with decreased red blood cell production or increased red cell destruction)
• taking iron supplements
• increasing the intake of iron-rich foods (eggs, spinach, artichokes, beans, lean meats, and seafood) and foods rich in cofactors (such as vitamin B6, folic acid, vitamin B12, and vitamin C) important for maintaining normal hemoglobin levels. Such foods include fish, vegetables, nuts, cereals, peas, and citrus fruits.

Individuals should not take iron supplements or other treatments for low hemoglobin levels without first discussing such treatments with their physician as side effects from these treatments and/or excess iron intake may cause additional problems. Also, iron supplements should be kept away from children as iron poisoning in young children can be fatal