Dr. Goswami Parth Rajendragiri
Pathology
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Patient's Query
Hello doctor,
I am concerned about my complete blood count. 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.
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 (red blood cells) 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.
Thank you.
Patient's Query
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 percent 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 (complete blood count) after few days.
I hope I have answered your question. Let me know if I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you for your prompt reply.
I had a follow-up CBC (complete blood count) after five days.
Hello,
Welcome back to the icliniq.com.
Following is my answer for your asked question. In the attached reports, the white blood cells (WBC), platelets, and red blood cells (RBC) are within the normal range. The packed cell volume (PCV) and hemoglobin (HB) levels are also not elevated, indicating that it does not seem to be polycythemia vera. The JAK2 test is negative, so there is no need to worry. Reticulocytes are premature forms of RBCs, and their levels can be elevated when there is blood loss. Since your blood was removed by phlebotomy, a slight increase in reticulocyte count could be due to that. There is no need to worry. However, if you have a smoking habit, it should be avoided. Echocardiography and X-ray can be planned to exclude cardiac and respiratory causes.
Hope I have answered your question. Let me know if I can assist you further.
Thank you.
Patient's Query
Hi doctor,
Thank you again for your time; I greatly appreciate it.
Hope all is well. I am still experiencing hematology issues. It seems my hemoglobin and hematocrit levels elevate to the point where I need a phlebotomy every five months or so to be safe. I did have the JAK 2 test for the 12 exon, which came back negative. However, upon further research, I realized that I might have missed something by not having a JAK 2 test that includes exons 12 to15. My hematologist has not yet determined the cause of this issue and has not confirmed it to be polycythemia vera. He mentioned that it's possible this could be related to sleep apnea, and I just got a CPAP (continuous positive airway pressure) machine, but I have read that the connection between elevated hematocrit or red blood cell elevation and sleep apnea is anecdotal. I can tell when my hematocrit is elevated because my skin feels weird and somewhat itchy. I am including a copy of my latest lab report. Do you think:
I am afraid the test I had for just the 12 exon might have missed something. I am so worried and frustrated because I do not know what is actually wrong with me. I look forward to your input.
Hi, Welcome back to icliniq.com. Sorry for late reply. Following is my opinion for your asked question.
If you are interested in studying polycythemia vera in detail, I recommend reading the WHO (World Health Organization) criteria for polycythemia vera, which can be downloaded online. The WHO criteria are as follows:
Major criteria:
Minor criteria:
To diagnose a case as polycythemia vera, either 3 major criteria or the first 2 major criteria and 1 minor criterion need to be met. Therefore, there is no need for studying other exon mutations apart from exon 12 and JAK2. Your erythropoietin level is normal based on your medical history. Hence, primary polycythemia seems less likely in your case, and you are most probably having a secondary benign polycythemia condition. High altitude and dehydration could be contributing factors, so I suggest maintaining a higher intake of water. Additionally, investigate with a chest X-ray and EKG (electrocardiogram) to rule out any respiratory or cardiac conditions if present. Consider reducing non-vegetarian food in your meals. If your CBC (complete blood count) results for hemoglobin and hematocrit keep increasing over the next few months, you can discuss with your doctor about planning a bone marrow aspiration to be sure that nothing abnormal is present. However, there is no need to worry or become frustrated. Focus on increasing water intake and reducing stress through yoga and meditation. There is no need for a bone marrow procedure at this moment. If, after a few weeks, the values continue to rise, then a bone marrow procedure can be planned to exclude polycythemia vera.
Hope I have answered your asked question. Let me know if I can assist you further.
Thank you.
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