Erythrocytosis - Causes, Symptoms, Diagnosis, and Treatment

What Is Erythrocytosis?

Erythrocytosis is characterized by an abnormally high concentration of red blood cells (erythrocytes) in the blood. The blood is made up of solid components such as red blood cells, white blood cells, and platelets. It also has a liquid component known as plasma. Erythrocytosis is defined as having an abnormally high number of red blood cells (a solid component) in comparison to plasma (the liquid part). Polycythemia is another term for erythrocytosis. Erythrocytosis is characterized by elevated levels of hematocrit (the number of red blood cells) and hemoglobin (an essential protein found in red blood cells).

What Are the Types of Erythrocytosis?

Erythrocytosis is classified into two types: primary and secondary. While both types result in an increase in red blood cells, they do so for different reasons.

1. Erythrocytosis Primary: This type of erythrocytosis occurs when the bone marrow has a problem that causes it to produce an abnormally large number of red blood cells. Primary erythrocytosis can be congenital, meaning the patients were born with it, or acquired, meaning they developed it later in life.

2. Erythrocytosis Secondary: This type of erythrocytosis occurs when the body produces an abnormally large number of blood cells, but it is not caused by a problem with the bone marrow. This type is usually caused by something affecting erythropoietin (EPO), a hormone produced by the kidneys that drive red blood cell production.

Absolute erythrocytosis is caused by a wider range of factors than relative erythrocytosis. It is further classified based on whether the causes are primary or secondary.

What Are the Causes of Erythrocytosis?

• Primary erythrocytosis is a condition that can be passed down through families. A mutation in genes controls how many RBCs the bone marrow produces and causes it. When one of these genes is faulty, the bone marrow produces excess RBCs even when the body does not require them.

• Polycythemia vera is another cause of primary erythrocytosis. This condition causes the bone marrow to produce an abnormally large number of RBCs. As a result, the blood becomes extremely thick.

• Secondary erythrocytosis is defined as an increase in RBCs caused by an underlying disease or medication use. Secondary erythrocytosis can be caused by a number of factors, including smoking, a lack of oxygen, such as from lung disease or living at high altitudes, and tumors.

• Steroids and diuretics are examples of medications.

• The cause of secondary erythrocytosis is not always known.

• The body can experience an oxygen deficit due to a variety of conditions. More red blood cells are produced as a result of an increase in EPO (erythropoietin) levels. Heart disease, lung disease, and sleep apnea are among the illnesses. Secondary erythrocytosis can also be brought on by a group of diseases known as hemoglobinopathy. Hemoglobin, a crucial protein that makes up red blood cells, is affected by these conditions.

What Are the Signs and Symptoms of Erythrocytosis?

The severity of the symptoms will be determined by the cause of the erythrocytosis.

• Headaches.

• Dizziness.

• Nosebleeds cause shortness of breath.

• Elevated blood pressure.

• Vision impairment.

• Itching.

• High blood pressure.

• Sweating at night.

• Unknown cause of weight loss.

• Severe joint pain, swelling, and tenderness (gout).

• Bleeding issues, including frequent nosebleeds and easy bruising.

• Itchy skin that may become worse after bathing in warm water.

• Pins and needles sensation in the arms, legs, hands, or feet.

• Burning and redness, particularly on the face, hands, and feet.

How to Diagnose Erythrocytosis?

Various tests and procedures may be performed by the healthcare provider to determine what is causing the high concentration of red blood cells. To begin, they will ask questions about the medical history, medications they are taking, lifestyle, and symptoms to rule out relative erythrocytosis (too little plasma in the blood). They may also conduct a physical examination.

• Complete Blood Count (CBC): This determines the number of red blood cells in the body as well as the hemoglobin and hematocrit levels. When making a diagnosis, the provider will take this information into account.

• Peripheral Blood Smear (PBS): The provider examines the blood under a microscope to look for abnormal cells during a PBS. Cells with unusual shapes or sizes could indicate a myeloproliferative neoplasm, such as polycythemia vera.

• Kidney and Liver Function Tests: These tests can detect kidney disease or tumors that cause high levels of EPO or red blood cells.

• Pulse Oximetry: This test determines the oxygen level in the blood. It entails applying a sensor to the finger that detects oxygen levels. This test can determine whether the erythrocytosis is likely caused by a condition such as heart or lung disease.

• EPO (Erythropoietin): EPO levels can help the provider determine whether they have primary or secondary erythrocytosis. Primary erythrocytosis causes low EPO levels, while secondary erythrocytosis causes high EPO levels.

• Urinalysis: The provider examines a pee sample for abnormalities during a urinalysis. Red blood cells in the urine may indicate that patients have kidney disease, which is causing them erythrocytosis.

How to Treat Erythrocytosis?

Treatment aims to reduce the risk of blood clots while also alleviating symptoms. It frequently entails lowering the RBC count.

• Erythrocytosis Treatments Include Phlebotomy (Also Called Venesection): This procedure involves removing a small amount of blood from the body in order to reduce the number of RBCs. This treatment may be required twice a week or more frequently until the condition is under control.

• Aspirin: Low doses of this over-the-counter pain reliever may help prevent blood clots.

• Medications That Decrease RBC Production: Hydroxyurea (Hydrea), Busulfan (Myleran), and interferon are examples.

How to Manage Erythrocytosis?

In the meantime, specific lifestyle changes such as,

• Quitting smoking can be beneficial.

• Keeping a healthy body weight.

• Controlling high blood pressure.

• Avoiding high-altitude environments.

Conclusion

Erythrocytosis is characterized by an abnormally high concentration of red blood cells (erythrocytes) in the blood. The healthcare provider will work with the patients to determine what is causing their high red blood cell concentration. Simple lifestyle changes, such as reducing or discontinuing medication, may resolve the problem in some cases. If the erythrocytosis is caused by a more serious condition, the provider will closely monitor the patient's condition to ensure they receive the necessary treatment. Smoking, hypoxia, and diuretics are common secondary causes.