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Q. My son's hemoglobin is around 17 to 18 g/dL. Is this contributing to his high blood pressure?

Answered by
Dr. Mubashir Razzaq Khan
and medically reviewed by Dr. Chithranjali Ravichandran
This is a premium question & answer published on Aug 11, 2021

Hello doctor,

My son is 30 years old. He is a kidney patient with high blood pressure. He is taking medications for high blood pressure for the last three years. I have attached the prescription and blood test reports. He also had gall bladder stone attacks two times, three years ago and one year ago. He had another gall bladder stone attack three weeks back.

His blood test shows Hb 19 g/dL and PCV 61%. He consistently had high Hb, around 17 to 18 g/dL. Is this a concern? Is this contributing to his high blood pressure?

Kindly help.

#

Hi,

Welcome to icliniq.com.

What kind of kidney problem is your son having? I went through the data provided by you (attachments removed to protect the patient’s identity). He has a considerably higher level of hemoglobin. His blood pressure is also an effect of high hemoglobin.

Elevated hemoglobin is seen in smokers, people living at high altitudes, congestive cardiac failure, chronic obstructive pulmonary disease, erythropoietin secreting adenomas of kidney, high oxygen affinity hemoglobin, rarely hereditary autosomal recessive erythrocytosis, and very rarely it could be a part of primary polycythemia. If all the causes are excluded, get JAK2 (Janus kinase 2 mutations test), exon 12, and CALR (calreticulin) mutations tested.

In case of secondary polycythemia, the treatment of elevated hemoglobin is to treat the cause. In primary polycythemia, if JAK 2 is negative, the treatment is therapeutic phlebotomy or venesection. The goal is to keep hemoglobin and hematocrit within the range for males, less than 50 hematocrits, and for a female, less than 48. And hemoglobin in males is up to 16 g/dL and for females up to 15 g/dL. Repeated venesections or phlebotomies can lead to micronutrient deficiency, especially deficiency of iron. The patient should be given micronutrient replacement therapy. For JAK 2 positive patients, tablet Ruxolitinib are delivered in a dose of 5 to 15 mg per day. Another option is IFN-alpha (immune interferon) in a low dose of 45 ug for a week in both JAK 2 positive or negative cases. CALR positive cases show superior results on this model. 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 would help.

Regards.


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