HomeAnswersHematologyhemoglobinMy hemoglobin, RBC, and hematocrit levels are always high, and my WBC levels are always low. Why?

What do having high hemoglobin, RBC, and hematocrit levels with low WBC levels indicate?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At November 1, 2022
Reviewed AtDecember 21, 2023

Patient's Query

Hello doctor,

Why is my hemoglobin, RBC and hematocrit always higher, and WBC always lower?

Kindly advise.

Hello,

Welcome to icliniq.com.

I understand your concern.

The information that you have provided is too little to comment on specifically. However, read the following write-up for causes and workup of high hemoglobin, hematocrit, and RBCs.

Elevated hemoglobin is seen in smokers, people living in high altitudes, congestive cardiac failure, chronic obstructive pulmonary disease, some erythropoietin-secreting adenomas of the kidney, and very rarely a part of primary polycythemia.

I suggest you rule out the causes of secondary polycythemia. If all the causes are excluded, get tested for JAK2, Exon12, and CALR mutations. Even in primary polycythemia, also called polycythemia rubra vera, these mutations are frequently negative. 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, including phlebotomy or venesection. The goal is to keep hemoglobin and hematocrit within the range that is less than 50 for males and less than 48 for females, and hemoglobin is 16 g/dL for males and 15 g/dL for females.

It can be combined with hydroxyurea, whose dose could be calculated according to the patient's weight. Repeated venesections or phlebotomies can lead to micronutrient deficiencies, especially iron. The patient should be given micronutrient replacement therapy. For JAK2-positive patients, tablets Ruxolitinib (Jakavi) are given in a dose of 5 to 15 mg per day. The other option is the tablet Pegasys (Pega Interferon Alfa 2 a) in low doses (45 ug/week) in both JAK2 positive or negative cases. CALR-positive cases show superior results in this mode. 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 from this but does not die from it.

I hope you found this useful.

Thank you.

Patient's Query

Hello doctor,

Thank you for the response.

I have shared my recent blood reports with you. My hemoglobin is within the range but seems to be high. I was taking iron after pregnancy as my ferritin levels were low. However, I have not taken it recently. The same is the case with hematocrit and RBCs. They are mostly high and get back within range sometimes. Can reduced intake of fluids in a day alter hemoglobin levels?

Please advise.

Hello,

Welcome back to icliniq.com.

Lack of fluids is the first thing to be corrected in case of borderline high hemoglobin, RBCs, and hematocrit.

Patient's Query

Hello doctor,

How much are the values affected by lack of fluids?

Hello,

Welcome back to icliniq.com.

By 10 to 20 %.

Patient's Query

Hello doctor,

Thank you for the reply.

Are they the values from mild dehydration? Why are my WBCs low? Can low estrogen cause low WBCs?

Hello,

Welcome back to icliniq.com.

Yes, mild dehydration could cause it. Your WBC (white blood cell) count is low due to low lymphocytes. It might be a viral etiology. Theoretically, estrogen does not affect lymphocytes.

Patient's Query

Hello doctor,

I do not feel like I have a viral infection.

Hello,

Welcome back to icliniq.com.

Most of the time, viral infections are asymptomatic. There might be a spike in fever, arthralgia, myalgia, flu, headache, cough, and dyspnea, in combination or alone. Once a viral infection hits, it can alter your immune system for weeks to months. Then, however, it reverts.

Patient's Query

Hello doctor,

Can WBC stay low for months after an infection?

Hello,

Welcome back to icliniq.com.

No, it might not be.

Patient's Query

Hello doctor,

Were you refering to WBC count when you said that the immune system is altered for weeks to months?

Hello,

Welcome back to icliniq.com.

The lymphocyte component of white blood cells is responsible for dealing with viruses. It gets altered upon viral insults to produce antibodies and other molecules called the immune response. This could cause the proliferation and suppression of lymphocytes. If lymphocytes are suppressed, the total white blood count is also suppressed, as might be in your case. However, there is nothing to worry about as it reverts back when the immune response against the virus subsides.

I hope this helps.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Mubashir Razzaq Khan
Dr. Mubashir Razzaq Khan

Hematology

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