What does increased hemoglobin mean?
All blood parameters are calculated on the volume of plasma, so when fluid is lost, the concentration of red blood cells increases, although their total number does not change. Such relative erythrocytosis occurs with vomiting, diarrhea, fever, taking diuretics and insufficient drinking. True erythrocytosis is a real increase in the mass of red blood cells. It can be secondary, when the bone marrow is stimulated by the hormone erythropoietin in response to oxygen deficiency, and primary, when bone marrow cells divide on their own due to genetic damage, as in polycythemia vera.
- Relative erythrocytosis during dehydration
- Secondary erythrocytosis due to lack of oxygen
- Primary erythrocytosis in bone marrow disease
- Family hereditary forms
- Erythrocytosis when taking hormonal drugs
Reasons
The most common cause of secondary erythrocytosis in adults is smoking: carbon monoxide binds hemoglobin, and the body compensates for this by producing new red blood cells. The second common cause is sleep apnea, in which breathing stops repeatedly during sleep and oxygen in the blood drops. Chronic lung diseases, heart defects and constant exposure to high altitude have the same effect. Separately, there are tumors of the kidneys and liver that produce erythropoietin, as well as taking testosterone and erythropoietin drugs, including in sports.
- Smoking, including hookah
- Obstructive sleep apnea syndrome
- COPD and other chronic lung diseases
- Congenital heart defects
- Long stay in the highlands
- Tumors of the kidneys, liver, kidney cysts
- Taking testosterone and erythropoietin
- Polycythemia vera with JAK2 mutation
Symptoms and dangers of erythrocytosis
Often, elevated hemoglobin is found by chance during a routine analysis. When there are complaints, they are associated with increased blood viscosity and slow blood flow: headache, tinnitus, dizziness, facial flushing, hot flashes. Polycythemia vera is characterized by itchy skin, which gets worse after a hot shower, and burning pain in the fingertips. The main threat is thrombosis: strokes, heart attacks, thrombosis of the leg veins and abdominal vessels. Therefore, the goal of treatment is not a beautiful analysis number, but to reduce the risk of vascular complications.
- Headache and dizziness
- Ringing in the ears, flickering of spots before the eyes
- Redness of the face and mucous membranes
- Itchy skin after a hot shower
- Burning pain and redness of fingers
- Heaviness in the left hypochondrium
- Increased blood pressure
- Thrombosis of arteries and veins
Diagnostics
First, the test is repeated to exclude dehydration and error: before donating blood, it is important to drink normally and not take the test against the background of an acute illness. If the increase is persistent, the doctor looks for the cause of the lack of oxygen: measures saturation, evaluates breathing during sleep, and prescribes a study of lung and heart function. The level of erythropoietin helps to separate the forms: with polycythemia vera it is reduced, with secondary erythrocytosis it is normal or increased. If bone marrow disease is suspected, JAK2 mutation testing is performed and referral to a hematologist.
- Repeated general blood test with hematocrit
- Measuring blood oxygen saturation
- Polysomnography for suspected sleep apnea
- Serum erythropoietin
- Ferritin, which is often reduced in polycythemia
- Ultrasound of the abdominal organs and kidneys
- Test for JAK2 mutation and consultation with a hematologist
- Assessment of pulmonary function and echocardiography according to indications
Treatment and observation
With relative erythrocytosis, it is enough to restore the water balance and retake the test. Secondary erythrocytosis is treated through the cause: smoking cessation, treatment of sleep apnea using a continuous positive pressure device, treatment of lung and heart diseases, withdrawal or correction of hormonal medications under the supervision of a physician. For polycythemia vera, regular bloodletting, low doses of acetylsalicylic acid are used to prevent thrombosis and, if indicated, drugs that suppress excess cell formation. Self-bleeding and thinning folk remedies are dangerous.
- Restoring drinking regime in case of dehydration
- Complete smoking cessation
- Treatment of sleep apnea and chronic lung diseases
- Reviewing testosterone and erythropoietin intake with your doctor
- Bloodletting as prescribed by a hematologist
- Low doses of acetylsalicylic acid for polycythemia
- Controlling blood pressure, cholesterol and weight
- Regular blood tests at scheduled times
