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HomeAnswersHematologyerythropoiesisShould I undergo further evaluation for polycythemia?

Is it possible to have low erythropoietin count and high RBC count together?


The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At September 16, 2017
Reviewed AtFebruary 13, 2024

Patient's Query

Hello doctor,

I am 27 years old male, 6 feet, and 180 lbs. I started a new job and the life insurance company wanted me to take a blood test. The results are attached. My blood test shows a low erythropoietin of 4.4 U/L (normal range 4.3 to 29) and high red blood cell count of 5.6x10^12/L (normal range 3.7-6). The insurance company now wants me to see a hematologist for polycythemia. What are the odds that my result is actually related to that? I was also just diagnosed with moderate sleep apnea.


Welcome to icliniq.com.

Your hemogram and erythropoietinlevels are normal. I would not evaluate you any further. They should not have asked for a hematology consultation, but if it is mandatory, get it done.

All the best and do well in your new job.

Patient's Query

Hello doctor,

Thank you for getting back to me.

The levels are within normal as you say, but what worries me is that they are on opposite ends of their limits. EPO low, and RBC high. Usually, high EPO produces red blood cells, but in my case, EPO is on the lower limit and my red blood cell count is close to the higher limit. Can you please elaborate on what can cause my red blood cells level to be so high if the EPO, that is controlling their production, is so low? I am just wondering as if my red blood cell drops, then my EPO could drop below the limit as well. Could it be related to my sleep apnea?


Welcome back to icliniq.com.

There are only two conditions where there ispolycythemia with low erythropoietin level. They are:

  1. Polycythemia vera. This is a mild cancerous condition, diagnosis of which can be confirmed by testing for JAK2 gene mutation and bone marrow examination. In this condition, the platelet count and WBC counts are also generally high, and the spleen size is increased.
  2. Congenital or familial polycythemia is a rare condition where there is a mutation in the erythropoietin receptor.

If your hemoglobin level were more than 16.5 g/dl, I would have asked you to do JAK2 mutation testing (V617F and exon 12). But, it is normal. Erythropoietin levels also, if it is outside the normal range, we need to worry about it.

Polycythemia can be due to sleep apnea, but in that case, erythropoietin level is high.

Please take it out of your head that your RBC count is high and EPO level is low. They are in the normal range.

You can do a hemogram six months later to ensure that the hemoglobin is in the normal range. If it is polycythemia, Hb level will increase by that time.

I hope you are convinced with the answer.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Girish Chandrakant Kamat
Dr. Girish Chandrakant Kamat


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