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Q. Will I need therapeutic phlebotomy lifelong for raised RBCs?

Answered by
Dr. Goswami Parth Rajendragiri
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 29, 2021

Hi doctor,

I am an obese person and a non-smoker. I am on an exercise program, and my weight reduced from 132 to 124 kg. I am under therapeutic phlebotomy once in three weeks (before once in two weeks). I found high counts in blood before 14 months during medical fitness blood test abroad and consulted a hematologist. I then underwent phlebotomy two times 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 142 kg, 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, 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, TC-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.

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#

Hello,

Welcome to icliniq.com.

Regular follow-up is 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 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 phlebotomy (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.

Best Regards.

Thank you doctor for the advice,

I am a non-smoker, and I have a history of cardiac or lung disorders. Can you please tell me how to control my BP level? Or should I take medicine to control BP? I have BP by hereditary. Is any further investigation needed for secondary polycythemia? Should I do phlebotomy lifelong? What are the complications regarding this? Should I take anticoagulants?

#

Hello,

Welcome back to icliniq.com.

Your blood pressure value is borderline high. For that, you can do lifestyle changes like 30 minutes walk daily and a low salt diet. However, if blood pressure still is not controlled, then I suggest 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 some patients can develop thrombosis resulting in a heart attack or stroke-like issue.

I suggest you with tablet Ecosprin 75 mg (Aspirin 75 mg) as an anticoagulant. No other anticoagulant needs to be started, as per 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.

Best Regards.


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