What are Red Blood Cells?
RBCs, also known as erythrocytes, are the most common type of cell found in the body. They pick up oxygen in your lungs, deliver it to tissues, and then remove carbon dioxide. Adults have approximately 25-30 trillion RBCs in total circulation at any given time, and every second, around 2 million new are made.1
RBCs can be impacted by iron levels, endurance training, smoking, hormone imbalances, and chronic disease. Too few red blood cells can lead to fatigue, shortness of breath, and brain fog, while too many can thicken the blood and increase cardiovascular strain.
Why Do Red Blood Cells Matter?
While sustaining life alone is a pretty important benefit, RBCs also:
- Power energy and endurance by delivering oxygen from the lungs to tissues for cellular energy production (ATP)
- Prevent fatigue and mental fog by removing carbon dioxide waste that would otherwise cause toxic buildup
- Help you maintain sharp cognitive function by supplying oxygen to your brain (which demands ~20% of your body’s total oxygen supply)2
- Support cardiovascular health by regulating blood pH and preventing excess acidity
- Contribute to healthy circulation by regulating blood thickness and flow
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How to Interpret RBC Levels
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity. Optimal ranges are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Benefits of an Optimal RBC
- Higher energy and stamina
- Better brain function and cognitive performance
- Improved circulation and cardiovascular efficiency
- Faster recovery and physical performance
- Better immune and cellular resilience
- Healthier metabolism
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Low Red Blood Cell Count (Anemia)
Symptoms
- Fatigue or weakness
- Shortness of breath
- Dizziness
- Cold hands and feet
- Brain fog or poor concentration
- Heart palpitations
Causes
- Iron deficiency (most common)
- Vitamin B12 or folate deficiency
- Chronic inflammation
- Blood loss (e.g., heavy menstrual bleeding; GI bleeding)
- Genetic disorders (e.g., sickle cell disease)
- Bone marrow problems (rare)
Healthspan impact:
- Chronic weakness and fatigue
- Cognitive impairment
- Lower immune function
- Reduced capacity to recover from illness
- Higher frailty and hospitalization risk, particularly in older adults
- Lower physical performance and exercise tolerance
- Increased risk of cardiovascular diseases3
High Red Blood Cell Count (Erythrocytosis)
Symptoms
- Headaches
- Dizziness
- Tiredness
- Blurred vision
- Flushed or reddish skin (often in the face, hands, and feet)
- High blood pressure
- Itchy skin, especially after hot showers
- Fatigue or brain fog
Causes
- Stress
- Sleep apnea
- Smoking
- Living at a high altitude
- Performance-enhancing drug use (e.g., anabolic steroids)
- Congenital heart disease
- Lung disease (e.g., COPD; emphysema)
- Blood cancer (rare)
Healthspan impact:
- Increased blood thickness
- Impaired circulation
- High risk of blood clots, heart attack, and stroke
- Higher cardiovascular and mortality risk, if persistent
How Hone Treats Out of Range Red Blood Cell Count
Your Hone physician will look at your red blood cell (RBC) count from your blood test results alongside hemoglobin, hematocrit, iron markers, symptoms, and overall health. Treatment depends on whether RBC levels are too low (anemia) or too high (erythrocytosis/polycythemia) and what’s driving the change.
- Short-term steroids* – to control autoimmune-related anemia4
- B12 injections – for pernicious anemia or severe B12 deficiency
- Iron infusion* – to correct severe iron deficiency
- Anti-inflammatory or immunomodulatory medications* – for autoimmune or chronic inflammatory conditions
- Erythropoietin (EPO)* – prescribed to those being treated for cancer with chemotherapy and have low RBC levels
*Your Hone Physician does not prescribe these treatments but will recommend further evaluation and help coordinate care with your primary care provider when medical treatment is indicated.
- Iron
- Vitamin B12
- Folate
- Vitamin C
- Omega-3 fatty acids5
- Avoid smoking or secondhand exposure
- Pair iron-rich meals with vitamin C to improve absorption (citrus; pepper)
- Prioritize protein intake
- Stay hydrated
- Get regular aerobic exercise
- Track menstrual flow (heavier cycles may increase iron needs)
- Prioritize getting 7-8 hours of sleep per night
Harigae H. (2022). The path from stem cells to red blood cells.
↑M.E. Raichle. (2002) Appraising the brain’s energy budget. Proceedings of the National Academy of Sciences of the United States of America.
↑M.E. Raichle. (2002) Appraising the brain’s energy budget. Proceedings of the National Academy of Sciences of the United States of America.
↑Y. Yulistiani. (2023) Mechanism of actions, efficacy, and long-term use of steroids in autoimmune hemolytic anemia (AIHA). Molecular and Cellular Biomedical Sciences.
↑M.I. McBurney. (2022) Omega-3 index is directly associated with a healthy red blood cell distribution width. Prostaglandins, Leukotrienes and Essential Fatty Acids.
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Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
