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Q. I have elevated hematocrit and hemoglobin levels. What could be the reason?

Answered by
Dr. Goswami Parth Rajendragiri
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Oct 26, 2020 and last reviewed on: Nov 03, 2020

Hello doctor,

I am concerned about my CBC. Three years back, my hematocrit has usually been in 40 (upper range). Last year, my doctor gave me testosterone injections. Five months ago, we found out my hematocrit went to 52.3. I stopped taking the infusion, and four months back, I went to a hematologist, and he ordered phlebotomy. My hematocrit returned to 48, which was checked a week later and a month later. Also, my Erythropoietin test and reticulocyte tests were both normal. For my three-month follow-up, which is this week, I had blood work and hematocrit, which is 50.4, and hemoglobin is 17.2. It seems like things have gone up. I spoke to my family doctor, and he said the higher altitude where we live could also cause elevated hematocrit and hemoglobin. I am just afraid about PV and hope I do not have that, but I am concerned that hematocrit and now the hemoglobin are high. The nurse who drew my blood thought I was a bit dehydrated because she had trouble finding a vein. She said they were flat. I was wondering what hematocrit and hemoglobin levels are consistent with polycythemia vera? Are they considerably higher than mine? I appreciate your thoughts and input. I take 10 mg Bystolic for blood pressure, 40 mg Atorvastatin, and 5 mg Xanax up to twice per day as needed for anxiety, one Baby Aspirin per day, and multivitamins.

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#

Hello,

Welcome to the icliniq.com.

I can understand your concern.

Following is my opinion on your asked questions. Initially, four months ago, your hemoglobin and hematocrit are elevated due to testosterone injections. You had secondary polycythemia at that time. Testosterone induced polycythemia can remain up to three to six month. In your latest report (attachment removed to protect patient identity), hemoglobin and hematocrit are borderline high. It could be due to high altitude, dehydration, smoking, or the persistent effect of testosterone-induced polycythemia. It does not seem polycythemia vera at this stage. The cause appears secondary.

Moreover, due to a non-vegetarian diet also contribute to a high hemoglobin level. I suggest you drink lots of water, at least two to three liters in a day. Do not smoke if you have a habit of it. Your levels are not too high. Your RBC and total count are within the limit. So do not worry.

Repeat your CBC (complete blood count) after one month of adequate water intake. If still hemoglobin and hematocrit elevated, then investigate with JAK2 (Janus Kinase 2) mutation and exon 12 mutations by PCR (polymerase chain reaction) and examine with Echocardiography and chest x-ray for further work-up.

Revert to me with repeated CBC (complete blood count).

I hope I have answered your question.

Let me know if I can assist you further.

Regards.

Hi doctor,

Thank you for your reply.

Yes, I will do that. I am seeing my hematologist this week for my third-month follow-up. Two questions in PV cases what usually do you see as the hematocrit level? I know it is a rare disease. Would it make sense now to repeat the reticulocyte test or erythropoietin test? I had them four months back. The result for reticulocyte count was 1.4, and erythropoietin was 10.4. Both these tests were taken about three weeks after I had the phlebotomy for the elevated hematocrit. I do not smoke or drink, and I am currently working on a plant-based diet. Thank you so much for all your advice. I genuinely appreciate it.

#

Hi,

Welcome back to icliniq.com.

Following is my answers for your asked questions.

In polycythemia vera which is primary polycythemia (blood cancer), hemoglobin level is usually goes above 17.5 and hematocrit goes beyond 50% along with high total count and RBC (red blood cells) count. There is no need to repeat EPO (Erythropoietin) or reticulocyte count.

If your hemoglobin and hematocrit will still remain high after adequate water intake then high altitude could be the reason. But at that time will investigate with JAK2 and exon 12 mutation investigation as well to exclude primary polycythemia.

Meanwhile drink more water and revert back with repeat CBC after few days.

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

Best regards.


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