Red Blood Cell Count (RBC)

Red blood cell production is similar to embryonic development and in maternity care the analysis of the RBC count as well as other red blood cell indices can help clues to help providers unravel complicated reproductive cases. 

Total Red Blood Cell Count (RBC) Test

The Blood Cell Count (RBC) measures the total number of red blood cells in a blood sample. It is part of the complete blood count (CBC).

Erythropoiesis (red blood cell formation) takes about 1 week to complete. There are multiple steps in the formation of red blood cells and each of the steps are influenced by or governed by hormones and nutrients. In the first phases of RBC production, erythroblast cells look like all other cells in the body with a nucleus and organelles. During this phase of development iron is accumulated as ferritin and the other components of hemoglobin are synthesized.

​Issues in RBC formation may be associated with dysfunction in the early phases of development. Most of the hemoglobin production occurs in the early phases of RBC development. 35% of hemoglobin synthesis occurs in young RBCs called reticulocytes.

The process of making RBCs is stimulated by Erythropoietin (EPO) which in turn is stimulated by hypoxia in cells, and iron concentrations.

RBC values are used to assess different types of anemia. Anemia is complicated and most of the concentration of diagnosis and treatment is centered around iron deficiency and iron supplementation. Several nutrients and hormones play into the production and function of RBCs. It is important to not narrow the focus of treatment to isolated iron supplementation. There are cases and presentations of anemia without iron deficiency, and supplementation with iron may cause a more severe presentation of anemia, or other complications in pregnancy. Correct differentiation and treatment are crucial to pregnancy and childbirth success. Certain patterns in the CBC will give you clues to underlying etiology of anemia or other complications.

For more information on anemia in pregnancy, please refer to chapter 9 of my book “Functional Maternity – Using Functional Medicine and Nutrition to Improve Pregnancy and Childbirth Outcomes.”

RBC in Pregnancy

Red blood cell production increases by 35% starting at 20 weeks gestation. Due to changes in hemodilution, total RBC counts do not increase and may show a decrease in blood work.

Changes may depend on birth experience. There is a slight decrease in counts due to the normal blood loss of pregnancy. Immediately after delivery, plasma volume decreases because of diuresis, and the blood volume returns to non-pregnant values. Hemoglobin and hematocrit increase consequently. Plasma volume increases again two to five days postpartum. Later, it again decreases. 

There is a slight increase in RBC counts in those living above 5,000 ft.

High RBC in Pregnancy

There is limited data on the implications of high red blood cell counts in pregnancy. The majority of research is centered around hemoglobin and hematocrit values.

Most Common Causes of High RBC in Pregnancy

• Dehydration
• Hypoxia
• Polycythemia Vera
• Iron Overload/Hemochromatosis
• Asthma
• Sleep Apnea
• Adrenal Hyperfunction
• Cystic Fibrosis
• Living at High Altitude
• Excess Erythropoietin Production

Low RBC in Pregnancy

Due to hemodilution, lower RBC count may be a normal presentation depending on gestational age. It is important to look at all complete blood count values, not just the RBC. 

Most Common Causes of Low RBC in Pregnancy

• Iron Deficiency
• Nutritional Deficiencies (Copper, Zinc, Vitamin C, Vitamin A, Vitamin D, Riboflavin (Vitamin B2), Pyridoxine (Vitamin B6), Vitamin B12, Folate, Molybdenum, Magnesium)
• Hypothyroidism
• Hemolysis
• Anemia of Inflammation
• Adrenal Hypofunction
• Environmental Toxin Exposure
• Mycotoxin Exposure
• Genetics

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Medical Disclaimer:
This content is for educational purposes only and is intended for licensed medical professionals. It is based on current research, subject to change, and not intended to diagnose, treat, or prevent any medical condition. This information does not replace consultation with a qualified healthcare provider. Seek professional medical evaluation and treatment from a licensed provider. Use of this information is at your own risk.​

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