Comparison of haemoglobin level between high altitude people and low altitude people

Short Communication

Comparison of haemoglobin level between high altitude people and low altitude people

Hafiza Saima Pracha1, Mumtaz Hassan2, Shahid Nazir3*, Muhammad Farhan Khan3, Baber Ali4, Iram Amir5

Adv. life sci., vol. 6, no. 3, pp. 97-99, Advanced Online Publication
*- Corresponding Author: Shahid Nazir (Email: s.nazir@uhs.edu.pk)
Authors' Affiliations

1. Women Medical Officer, Primary & Secondary Healthcare, Govt of Punjab
2. District Headquarter Hospital skardu, Gilgit Baltistan, Pakistan
3. University of Health Sciences, Lahore, Pakistan
4. University of Lahore, Pakistan
5. Agriculture University Faisalabad, Pakistan
 [Date Received: 14/03/2018; Date Revised: 18/03/2019; Date Published Online: 27/03/2019]

Abstractaa download_button
Introduction
Methods
Results
Discussion
References 

Abstract

Background: Hemoglobin is the iron holding and oxygen carrying protein found inside the red blood cells. Studies have been done on Hb level variations in gender, race and region but no comparative study on different altitude effects in Pakistan is reported. Comparison of Hemoglobin level between people living at high altitude and low altitude was done in this study. Samples from district Skardu Gilgit-Baltistan, Pakistan were used as high-altitude samples and samples from district Lahore, Pakistan were utilized as low altitude samples. Samples were obtained from those people who don’t have any haemoglobinopathies.

Methods:  50 blood samples were collected for this study; 25 individuals were from low altitude level and 25 of high-altitude level. Estimation of hemoglobin concentration was done by Cyanmethemoglobin method to compare the individuals HB from low altitude with high altitude.

Results: All the blood samples were properly analyzed, and the results extracted from the samples, living at low altitude were compared with those living at high altitude. Mean and standard deviation values were calculated, and they found to be different for both populations, people at high altitude and the people living at low altitude. 25 residents of high altitude showed following results of hemoglobin: mean=15.0 and SD=0.632. On the other hand, 25 individuals of low altitude revealed these results: mean=14.53 and SD=0.633.

Conclusion: There was a significant difference in Hb level in blood at high altitude (7500 feet) and low altitude (711 feet from sea level) P=0.004. 

Keywords: Hemoglobin, Standard Deviation

Introduction6th button-01

Haemoglobin is the iron holding and oxygen carrying protein found inside the red blood cells. This protein delivers many vital nutrient to human life [1]; furthermore, conveyances the toxic constituent carbon dioxide to the lungs for exhalation.

Humanoid haemoglobin is molded commencing two units of globin chains with a haem group. Seven diverse globin groups are produced in healthy subject; four are transitory developing hemoglobin stated as Haemoglobin Gower 1, Haemoglobin Gower 2, Haemoglobin Portland 1, and Haemoglobin Portland 2. Haemoglobin F is the main Hb of fetus lifecycle and includes the key fraction of Hb set up at delivery. Haemoglobin A is a key Hb that originates in grown-ups and kids. Haemoglobin A2 and Haemoglobin F are established in minor amounts in fully-grown (almost 2-3.3% and 0.2-1.0%, in turn). The grownup amounts of Hb A, A2, and F are typically achieved by 6-12 months [2,3]. It is a conjugated protein of molecular weight 64000 consisting of twosomes of polypeptide chains to each of which a haem is attached. The structure of the haemoglobin molecule may be viewed at four levels of organizational complexity. The basic arrangement of linked amino acids forming four polypeptide chains, each attached to a haem molecule is the primary structure. Each chain is arranged in a series of eight helical segments joined by short non-helical segments, and this is referred to as the secondary structure. The folding of each twisted chain into a specific three-dimensional configuration is the tertiary structure. The four folded chains fit closely together to form a compact tetrameric molecule known as the quaternary structure [4]. Studies have been done on hb level variations in males and females and it is found that women have 12% less hb level as compared to males of same race and origin due to Hb levels oxygen carrying capacity or need of oxygen in a body also differ in male and female [5]. Although, altitude was not considered in those studies but  at high altitude oxygen level is low as compared to lower altitude and hb level also differ with the altitude [6].   

Methods6th button-01

Apparently healthy adult individuals with age ranging between 15 to 25 years (only males) were used as samples. Twenty-five (25) were the permanent resident of high altitude (7,500 feet from sea level) of Skardu valley and twenty-five individuals were from the low altitude (711 feet from sea level) belonging to Lahore. Total of these fifty individuals were the samples for this study. The study design was Comparative Observational and that did not involve any treatment. Estimation of hemoglobin concentration was done by Cyanmethemoglobin method [7,8] to compare the individuals HB from low altitude with high altitude.

When blood sample was diluted in a solution containing potassium cyanide and potassium ferricyanide (Drabkin’s solution). It transforms haemoglobin (Hb) and methaemoglobin (Hi) to cyanmethaemoglobin (HiCN) which is a steady composite; this technique was used as standard for the study. The absorbance of the solution was measured in spectrophotometer at a wavelength of 540 nm which was associated with a standard solution of HiCN. Venous blood samples were collected in EDTA vials. 20 μl of blood from each sample was added to 5 ml of Drabkin’s and well mixed by inverting the tube numerous times. It was then allowed to stand at room temperature for 3 – 5 minutes so that all Hb is transformed into HiCN. The absorbance was measured by using the spectrophotometer at 540 nm. [8]

Absorbance of identified standard was also measured in the spectrophotometer with respectively each group of tests to reduce the chances of error. The estimation of Hb concentration was done by using the Cyanmethemoglobin method and the following formula was used for calculation: -

Hb(g/L) = Absorbance of test x Concentration of standard 
                            Absorbance of Standard

Data collected was processed and analyzed using SPSS 17.0 (SPSS Inc. Chicago) for statistical analysis. The continuous variables were expressed in the form of Mean + SD.  

Results6th button-01

Twenty-five (25) individuals of high altitude gave these results of Hb (Mean= 15.1 and S.D =0.632). In the same way, 25 individuals from low altitude showed the following results of Hb (Mean= 14.5 and SD=0.633). There was a significant difference in Hb level at high altitude (7500 ft) and low altitude (711 ft) that is from the sea level. It gives the value for P= 0.004.

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Discussion6th button-01

Hemoglobin level in blood based on genders and origin of samples were studied previously but this study was conducted to find Comparison of hemoglobin level between high altitude people and low altitude people living in Pakistan. Individuals of high altitude have the mean value of Hb=15.1 and Standard Deviation=0.63. In the same way, mean and SD values were calculated for low altitude residents and the resulting mean value was 14.5 and SD was 0.633. There is a significant difference in Hb level at high altitude (7500 ft) and low altitude (711 ft from sea level), P=0.004. This difference clearly indicates that altitude affects the level of hemoglobin in an individual. High value of Hb level was found in the people living at higher altitude as compared to the people of lower altitude. Significant difference of Hb values also determined the availability of oxygen in the habitat. Oxygen level is low at higher altitude so the people having high altitude habitat have high blood hemoglobin level to maintain the oxygen level and these changes are done by physiological and morphological adaptations acquired during the developmental period [9]. The purpose of this research is also to differentiate people of high altitude misleading diagnosed in lower altitude area hospitals as polycythemia rubra Vera because no proper data on hemoglobin levels of  different altitude habitat were previously published in pakistan. 

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

References6th button-01

  1. Barrett KE Ganong's review of medical physiology. 2010; 4; McGraw-Hill Medical New York.
  2. Gruchy G. De Gruchy’s clinical haematology in medical practice. (1989); 5th Ed. F. Firkin.
  3. Bain BJ, Lewis SM, Bates IJD, haematology Lp. Basic haematological techniques. (2006); 419-46.
  4. Handin RI, Lux SE, Stossel TP Blood: principles and practice of hematology. 2003: 1; Lippincott Williams & Wilkins.
  5. Murphy WGJBr. The sex difference in haemoglobin levels in adults—mechanisms, causes, and consequences. (2014); 28(2): 41-47.
  6. Lesperance L, Wu AC, Bernstein HJCP. Putting a dent in iron deficiency.(Cover Article). (2002); 19(7): 60-73.
  7. Beall CMJHb. Tibetan and Andean patterns of adaptation to high-altitude hypoxia. (2000); 72(1): 201-228.
  8. Anwar MGM. Manual of laboratory medicine (2003); 284-285.
  9. Frisancho ARJRp. Origins of differences in hemoglobin concentration between Himalayan and Andean populations. (1988); 72(1): 13-18.

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