09/09/2026
Patient: "Wow 14 ang Hemoglobin ko. Butina lang . Mas mataas mas maganda😄"
FocusSym :" ah eh, i think we need to clarify something"
Patient: "hindi ba tama ako?"
There are several common misconceptions about high hemoglobin (Hb) in hemodialysis (HD) patients.
Common misconceptions
Misconception vs. Reality
“The higher the Hb, the better.” Not necessarily. In CKD/HD, pushing Hb too high can increase cardiovascular and thrombotic risk.
“If Hb is high, give more ESA to keep it high.” ESA therapy is adjusted to avoid excessive Hb levels, not to normalize Hb like in a healthy person.
“High Hb means the patient is well hydrated.” High Hb can actually occur with hemoconcentration/dehydration, especially after excessive ultrafiltration.
“A high Hb always means the patient has too many red blood cells.” Not always. Fluid status can change the measured Hb concentration without a proportional increase in red-cell mass.
“If Hb is high, the patient doesn't need monitoring.” High Hb may require assessment of ESA dose, volume status, hypoxia, smoking, sleep apnea, or other causes.
“Stopping ESA is always the answer.” The cause matters. ESA dosing should be individualized based on the Hb trend, treatment, and clinical situation.
Important HD point:
A post-dialysis Hb that is higher than pre-dialysis Hb can sometimes reflect hemoconcentration from ultrafiltration, rather than a true increase in red blood cell production.
For example:
Pre-HD: Hb 10.5 g/dL
⬇️ Fluid removed during HD
Post-HD: Hb 12.0 g/dL
That doesn't necessarily mean the patient suddenly produced more RBCs—the blood became more concentrated because plasma volume decreased.
FocusSym takeaway:
“High Hb ≠ automatically healthy. In HD, always consider ESA therapy + fluid status + the Hb trend.”