Why do I have persistently high Hb and HCT?

Question

Hi doctor,

I am a 31-year-old female. I have a history of celiac disease and a past medical history of Hodgkin's lymphoma, a stage 2 cervical lymph node, and tumors in my chest. I had a blood test last week, which showed a B12 and folic acid deficiency, a raised hemoglobin of 161, and a raised hematocrit of 0.465.

I have had a persistently elevated hemoglobin for three years, but it has never been as high as 161. It varied between the levels of 144 and 157. My doctor is concerned about my current reading of 161, as I have celiac disease.

Can you offer me any advice?

I am concerned about the occurrence of Hodgkin's disease or that I may have polycythemia vera.

Kindly guide.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

You are having celiac disease, in which, because of malabsorption, vitamin B12 deficiency and folate deficiency can occur. This deficiency can also be developed if polycythemia is present, resulting in more proliferation.
Here, hemoglobin and HCT are high as per history. Hence, if it is persistently elevated, then polycythemia, a form of blood cancer, should be ruled out. For that one molecular investigation, the detection of the JAK2 mutation is useful.
If polycythemia is confirmed, then phlebotomy is done regularly, and other suitable medication is prescribed, like Anagrelide, which prevents thrombosis in such cases if the platelet count is also high in CBC.
Rule out metastatic Hodgkin's lymphoma also, as you have a history of a CT scan and bone marrow biopsy study.
Celiac disease is a form of autoimmune disease, and a gluten-free diet is prescribed for that.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.