How long do I need therapeutic phlebotomy for my raised RBC?

Question

Hi doctor,

I am an obese person and a non-smoker. I am on an exercise program, and my weight has reduced from 291 lbs to 273 lbs. I am under therapeutic phlebotomy once in three weeks (previously once in two weeks). I found high counts in my blood before 14 months during a medical fitness blood test abroad, and consulted a hematologist. I then underwent phlebotomy twice and got all normal counts for medical fitness. After nine months, I reached my hometown and consulted again with a hematologist.

I underwent evaluation of PV and am undergoing phlebotomy frequently. When I noticed the blood count disorder, my weight was 313 lbs, and now it is reduced to 124.

I have no history of chronic lung disorders. I was evaluated for polycythemia vera and erythrocytosis. My EPO is 20.6 mU/mL, and JAK2 mutations (exons 12 and 14) are not detected.

Creatinine is 0.9 mg/dL, and Uric acid is 7.1 mg/dL. CBC taken five days ago shows Hb-16.6 gm/dL, RBC-7.2 million cells/mcL, PCV-53.5%, WBC-10,000 cells/mcL, PLT 2.64 platelets/mcL, and TLC 194 lymphocytes/mcL. USG shows borderline splenomegaly of size 13 cm and mild right proximal hydroureteronephrosis. Also, I have a history of renal stone disease.

Kindly guide me.

Thank you.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Regular follow-up is, in my opinion, for your question. I have seen the attached reports (attachment removed to protect the patient's identity).

Your JAK2 (Janus kinase 2) report is negative, and EPO (erythropoietin) is within the limit. So polycythemia vera, like blood cancer, is less likely. However, you can have a secondary polycythemia condition.

If you have any smoking history, then stop it. If you have any cardiac or respiratory problems, mention them.

You can undergo therapeutic phlebotomy (a procedure to remove RBCs in the blood) under the guidance of your hematologist to control RBC(red blood cells) and PCV (packed cell volume).

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I can understand your concern.

Your blood pressure value is borderline high. For that, you can do lifestyle changes like a 30-minute walk daily and a low salt diet. However, if blood pressure is still not controlled, then I suggest the tablet Telmisartan 40 mg.

No other investigation is needed for secondary polycythemia because you do not have any cardiac or lung problems.

The main complication of polycythemia is that some patients can develop thrombosis, resulting in a heart attack or stroke-like issue.

I suggest you take tablet Ecosprin 75 mg (Aspirin 75 mg) as an anticoagulant. No other anticoagulant needs to be started in my opinion.

Phlebotomy needs to be done for at least four to five months in such cases. Consult with your hematologist for further details.

I hope I have answered your question. Let me know if I can assist you further.

Thank you.