What causes elevated Hb, hematocrit, and platelet count?

Question

Hello doctor,

My platelets have been high for the past few years without my knowledge (as no doctor ever mentioned it), but just recently, I saw my cardiologist, and he requested a blood test. My platelets were 619, and he referred me to a hematologist who, in turn, prescribed Hydroxyurea 500 mg. (My hemoglobin is 18.4 and hematocrit 55). I checked my past results and found I have had high platelets (400 to 715) for the past four years.

I am very concerned about the side effects of this medication (liver and kidney, since I have a history of kidney stones) and how it changes the size of the red cells. I am a 62-year-old male. Current medications I am taking are Amlodipine 5 mg, Metoprolol Succinate ER 25 mg twice daily, Aspirin 82 mg, Coq 10 and Omega 3, and Simvastatin 20 mg.

Please guide.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen your reports (attachment removed to protect patient identity) and here is my advice. In the last two reports, particularly your Hb (hemoglobin), hematocrit, and platelet counts are high. So, it is suggestive of polycythemia or a myeloproliferative-like condition. Polycythemia can be secondary or primary. Secondary causes include cardiac disease, respiratory disease, or smoking. So, it can be ruled out before moving on further.

The primary cause of polycythemia includes polycythemia vera which is a malignant condition. So, to be on the safer side, you can investigate with Jak2 and exon 12 mutation study by a molecular method to rule out polycythemia vera. The second investigation should be erythropoietin estimation.

Hydroxyurea has side effects in some patients, but it is the best drug in cases of essential thrombocythemia, such as a myeloproliferative disease.

I hope this helps you.

Thank you.