What could be the reason for elevated hemoglobin levels?

Hi,

Welcome to icliniq.com.

I went through your query and understood your concern.

Elevated hemoglobin is seen in smokers, people living at high altitudes, congestive cardiac failure, chronic obstructive pulmonary disease, some erythropoietin-secreting adenomas of the kidney, and very rarely, it can be a part of primary polycythemia. So, we should rule out the causes of secondary polycythemia. If all causes are excluded, get JAK2 (Janus kinase 2 genes) exon 12 mutation and CALR (Calreticulin) mutations tested. Even in primary polycythemia, also called polycythemia rubra vera, these mutations are often negative.

In cases of secondary polycythemia, the treatment of elevated hemoglobin is to treat the cause.

1. In primary polycythemia, if JAK2 is negative, the treatment is therapeutic phlebotomy or venesection.

2. The goal is to keep hemoglobin and hematocrit values within the range for males, with less than 50 %, and for females with less than 48 %.

3. The normal range of hemoglobin in males is at 16 g/dL and in females up to 15 g/dL.

4. The treatment can be combined with Hydroxyurea (antimetabolites), for which the dose can be calculated according to the weight of the patient.

5. Repeated venesections or phlebotomies can lead to micronutrient deficiency, especially iron.

6. The patient should be given micronutrient replacement therapy.

7. For JAK2-positive patients, Jakavi (Ruxolitinib) tablets are given at a dose of 5 to 15 mg per day.

8. Another option is administering IFN alpha (Interferon alfa) (Pegasys) in low doses (45 ug in a week) in both JAK2 positive and negative cases. CALR positive cases show superior results in this mode.

Kindly consult a specialist, talk to them and take the medications with their consent.

It could take years to cure the disease. Meanwhile, along with all therapeutic modalities, thrombophilia prophylaxis is given. This is not a life-threatening disease. The patient can die with this but does not die of it.

I hope this has helped you out.

Take care.