I underwent routine bloodwork during my regular gynecological checkup. It showed a hemoglobin of 16.4 g/dL and hematocrit of 47.3 %. All other laboratory values are normal, and I do not have any symptoms. I am currently on Norethindrone for birth control and Spironolactone 100 mg for cystic acne. My doctor has referred me to a hematologist. Is this necessary? Should I be worried?
Elevated hemoglobin is seen in dehydration, smokers, people living at high altitudes, congestive cardiac failure, chronic obstructive pulmonary disease, erythropoietin secreting adenomas of the kidney, and rarely could be a part of primary polycythemia. I suggest you rule out the causes of your elevated hemoglobin. If all causes are excluded, then kindly get JAK2 (Janus kinase 2), CML (chronic myelogenous leukemia) mutation tests done. Even in primary polycythemia, also called polycythemia rubra vera, these mutations will be negative frequently. In cases of secondary polycythemia, the treatment of elevated hemoglobin is to treat the cause. In primary polycythemia, if JAK2 is negative, the treatment is therapeutic phlebotomy or venesection. The goal is to keep hemoglobin and hematocrit within range.
But 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 are given in a dose of 5 to 15 mg per day. Another option is IFN-alpha (immune interferon) in low doses in both JAK2 positive and negative cases. Meanwhile, along with all therapeutic modalities, thrombophilia prophylaxis is given. This is not a life-threatening disease. So, do not worry.
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