Is it bad to have high level of hemoglobin?

Question

Hi doctor,

My hematology report shows a hemoglobin of 18.8 g/dL, hematocrit of 54.0 % and mean corpuscular hemoglobin concentration of 34.7 g/dL, and red cell distribution width of 19.3 % (all are high). The other parameters such as RBC and WBC are found normal. I have a comment on the morphology of RBC as predominantly normocytic normochromic with mild anisocytosis. The WBC shows normal morphology and platelets are adequate. Does having a high level of hemoglobin is bad and what is the cause behind it?

Answer 1

Hi,

Welcome to icliniq.com.

You have a condition showing an increased level of hemoglobin. Elevated hemoglobin is seen in smokers, in people living at high altitudes, congestive cardiac failure, chronic obstructive pulmonary disease, some erythropoietin-secreting adenomas of the kidney, and very rarely, it could be a part of primary polycythemia. It is necessary to rule out the causes of secondary polycythemia. If all the causes are excluded, you need to get JAK2 (Janus kinase 2), Exon12, and CALR (calreticulin) mutations tested.

Even in primary polycythemia, also called polycythemia rubra vera, these mutations are frequently negative. In primary polycythemia, if JAK2 is negative, then the treatment is therapeutic phlebotomy or venesection. The goal is to keep hemoglobin and hematocrit within the range, and for males, it should be less than 50 percent, and for females, it should be less than 48 percent.

The hemoglobin level has to be 16 mg/dL for males and then it should be 15 g/dL for females. It can be combined with hydroxyurea and the dose is calculated according to the weight of the patient. Repeated venesections or phlebotomies can lead to micronutrient deficiency especially iron. The patient should be given micronutrient replacement therapy.

For JAK2 positive patients, tablet Ruxolitinib is given in a dose of 5 to 15 mg per day. Another option is IFN (interferon) alpha in a low dose of 45 ugs per week in both JAK2 positive or negative cases. CALR positive cases show superior results in this mode. It takes a few years to cure the disease. Meanwhile, along with all the therapeutic modalities, thrombophilia prophylaxis is given. This is not a life-threatening disease.