In this case, the patient's hemoglobin (Hb) values are consistently above the reference range given by Dacie and Lewis, and they are also above the cut off for Polycythemia as per WHO. However, it is important to note that a diagnosis of Polycythemia should not be made based on Hb values alone.

Polycythemia is a condition characterized by an increase in the number of red blood cells, which may be due to a variety of reasons. In addition to Hb values, other laboratory tests such as hematocrit (Hct), red blood cell count (RBC), and serum erythropoietin levels may be used to help diagnose and differentiate the various types of polycythemia.

Furthermore, the diagnosis of polycythemia requires clinical correlation, including a thorough medical history, physical examination, and consideration of other factors such as smoking and altitude. Asymptomatic cases of polycythemia may not require treatment, while symptomatic cases may require further evaluation and management.

Therefore, in this case, it would be appropriate to further investigate the patient's condition by performing additional laboratory tests and obtaining a detailed medical history and physical examination. A diagnosis of polycythemia should not be made based on Hb values alone, and should be made in consultation with a qualified healthcare professional.

Credit: Mostly AI tools

Thank you Mr. Mohammad. However my query is not limited to this particular incident. What does one do in a case where the result is close to the cut off, either above or below (it could be any lab test). Especially where there is no facility for further investigation.

Address the age issue. Need distribution and threshold that are both age related and related to the distribution pattern. We need values related to values which can fit into disease possibilities. We need to indicate further testing when a value is both a normal range and a disease range. For example a patient with memory loss and B12 assay value of 250! That value is indeterminate!! the report should suggest follow up such as methyl malonic acid and homocystein. A neurological examine.

Thank you for posting question and raising this important query. In such borderline cases, one must always interpret based on clinical history, examination and other pertinent lab findings. E.g in your case where hb is constantly in the borderline high range and patient is asymptomatic, you should consider ruling out smoking history, occupation, altitude. Etc. Rule out secondary causes like get an ECG, SPO2, usg abdomen pelvis and KUB for any kind of underlying pathology which hasn't been evident clinically as yet. And then correlate with Serum Epo, JAK2 mutation analysis accordingly. Serial monitoring is suggested. If these are not available at your setup ,referral to higher centres is recommended.

Hope that helps answer your question!

A few case details are missing in the above question such as gender age, and medication condition of the person.

If it's a male it's not high. If it's a female also we often find high hemoglobin levels above 16 in athletes and in people who live in high altitudes and with some medical history of lung diseases.

Always need to remember that the 5% of the healthy population might have their values out of the reference range

Moreover, to identify poly thalassemia we need to look into other parameters such as RBC count and hematocrit first, rather than considering the hb levels.

I agree. One concern is about feasibility. By that I mean the relevant cloud data needs to integrated into the lab report. My guess is very feasible. But I do worry about the strong willed privacy advocates. Hopefully not to worry! I am at great discomfort with those who think lab results need to fit a certain distribution with 2.5% cut offs. It is old and established practice but from a data management view it is pathetic. We can't be wedded to old antiquated practices. How to characterize our lab outputs might be answered with collaborative work. For example thalassemia with hematologists who have a generous experience with the hemoglobinopathies. B12 with neurologists, psychiatrists, hematologist and gastroenterologists. Can we agree to some B12 algorithms wherein a methyl malonic acid and homocysteine are automatically performed? or suggested to be performed? My feeling is there are many prospective conversations to come.

We can write a program as listed below. I propose that all of us contribute to this effort. I will write the program. You all provide the data and test cases and we publish

This is basic Python program to calculate the HB reference levels and threshold:

```

# Define the Hemoglobin values for the medical study

hb_values = [12.5, 13.2, 11.8, 14.5, 12.9, 13.7, 10.4, 15.1, 11.7, 12.6]

# Calculate the mean Hemoglobin value

mean_hb = sum(hb_values) / len(hb_values)

# Calculate the standard deviation of Hemoglobin values

std_hb = (sum([(i - mean_hb) ** 2 for i in hb_values]) / len(hb_values)) ** 0.5

# Calculate the lower and upper Hemoglobin reference levels

lower_ref_level = mean_hb - (2 * std_hb)

upper_ref_level = mean_hb + (2 * std_hb)

# Calculate the Hemoglobin threshold

threshold = (lower_ref_level + upper_ref_level) / 2

# Print the results

print("Mean Hemoglobin value:", mean_hb)

print("Standard deviation of Hemoglobin values:", std_hb)

print("Lower Hemoglobin reference level:", lower_ref_level)

print("Upper Hemoglobin reference level:", upper_ref_level)

print("Hemoglobin threshold:", threshold)

```

In this program, we first define the Hemoglobin values for the medical study in a list called `hb_values`. We then calculate the mean and standard deviation of these values using the `sum()` and `len()` functions, and the `**` operator for exponentiation.

Next, we calculate the lower and upper Hemoglobin reference levels by subtracting and adding two times the standard deviation from the mean Hemoglobin value, respectively. Finally, we calculate the Hemoglobin threshold by taking the average of the lower and upper reference levels.

The program then prints out the results of the calculations using the `print()` function.

Note that this is just a basic example, and there are many factors that can affect Hemoglobin levels in medical studies. You may need to adjust the calculations or use additional data to obtain more accurate reference levels and threshold for your specific study.

Well, this was a boy aged 17. Had a syncopal attack. CBC was done as a routine. Since it was borderline we repeated it. No smoking, heart disease etc. Parents worried and affording. So we did EPO and JAK2 both negative. That ends the story but the dilemma persists..