Is it possible to have low erythropoietin count and high RBC count together?
Patient's Query
Hello doctor,
I am a 27 years old male, 6 feet tall,, 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 a 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.
Please help.
Thank you.
Hello,
Welcome to icliniq.com.
Your hemogram and erythropoietin levels 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.
I hope it helps.
Thank you.,
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 is low, and RBC is 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 upper limit.
Can you please elaborate on what can cause my red blood cell level to be so high if the EPO, that is controlling their production is so low?
I am just wondering if my red blood cell drops, then my EPO could drop below the limit as well. Could it be related to my sleep apnea?
Please help.
Thank you.
Hello,
Welcome back to icliniq.com.
There are only two conditions where there is polycythemia with a low erythropoietin level. They are:
- Polycythemia vera. This is a mild cancerous condition, the diagnosis of which can be confirmed by testing for the JAK2 gene mutation and bone marrow examination. In this condition, the platelet count and WBC count are also generally high, and the spleen size is increased.
- 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 them.
Polycythemia can be due to sleep apnea, but in that case, erythropoietin levels are high.
Please take it out of your head that your RBC count is high and your 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, the Hb level will increase by that time.
I hope you are convinced by the answer.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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