If I quit smoking, will my RBC, hemoglobin, and PCV levels come back to normal?

Hi,

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I have gone through your attached reports (attachment removed to protect patient identity).

1. The diagnosis is polycythemia. Polycythemia can be secondary or primary. Secondary polycythemia occurs because of hypoxia, which activates the oxygen sensor and more erythropoietin is secreted, so consequently, more hemoglobin, RBC, and hematocrit are present.
2. You have a history of smoking, so you are prone to COPD (chronic pulmonary obstructive disease) or cardiac problem, for which chest X-ray, spirometry, EKG etc., tests need to be done. If a specific cause if found, it is treated accordingly. For example, if COPD is present, then Ipratropium like bronchodilator might be needed.
3. Now let us discuss primary polycythemia, for that JAK2 mutation study should be done with PCR testing. It is a myeloproliferative neoplasm, and the prognosis of primary polycythemia is not so good as compared to secondary polycythemia.
4. So, these workups need to be done, along with your complete physical examination. With keeping my answer in mind, consult a nearby physician for examination.

I hope your concern is solved.

Hi,

Welcome back to icliniq.com.

Here is my further opinion regarding your case. I have gone through your attached reports of chest x-ray and echocardiography (attachment removed to protect patient identity).

• You are not having any respiratory problems like emphysema or bronchitis. But you do have smoking-induced hypertension, and from hypertension, you have developed left ventricular hypertrophy and diastolic dysfunction.

• For that, I suggest taking Telmisartan, it will reduce the workload on the heart. You have to stop smoking strictly for early improvement. You can attend smoking de-addiction campaign if needed.

• It has been just 15 days of quitting smoking. So, if you strictly stop smoking, within three to four months, hematological and clinical recovery will be there. If there is no improvement noted hematologically, then JAK2 mutation should be checked with PCR testing.

• Your blood pressure should be checked regularly. If your doctor feels to start beta blocker, then it can be started additionally. Smoking is most common cause for secondary polycythemia.

• Phlebotomy procedure is available for high hemoglobin, but in your case, it is not suitable as per my opinion. Regularly take the antihypertensive medication and stop smoking.

Hi,

Welcome back to icliniq.com.

Yes, I can remember your case.

In primary polycythemia, usually hemoglobin level is more than 17.5 and Hct (hematocrit) value is more than 55%. Also, typically high WBC and platelet count can be present as it is a primary myeloproliferative disorder. These typical values are not present here (attachment removed to protect patient identity).

As you have an itchy skin problem, it can be present because of allergy inflammation or from hyper histamine secondary to polycythemia vera. So, following workup is needed in your case.

1. Skin examination, as the skin will be rudy and thick in primary polycythemia.
2. Liver, Spleen palpation because most of the case of primary polycythemia have splenomegaly.
3. WBC and platelet count.

If splenomegaly present then you should check for JAK2 mutation as soon as possible. If needed bone marrow study also can be done.

For itchiness and high eosinophilia, a drug such as Allegra M (combination of Fexofenadine and Montelukast) can be prescribed for ten days and repeat CBC (complete blood count). Phlebotomy is usually needed if PCV (packed cell volume) high with higher than 55% at least. If PCV persistently raised more than 55% then to eliminate the risk of thrombosis phlebotomy might be needed.

Hi,

Welcome back to icliniq.com,

According to the history and report provided (attachment removed to protect patient identity), WBC and platelet counts are within limits. No splenomegaly and so chance of primary polycythemia seems less. HB value now is 16.8. Hence, you are improving. Smoking should strictly be prohibited.

The causes of eosinophilia are allergic inflammation, asthma, a parasitic infection of the intestine, etc. Here it seems to be skin allergic reaction for which Allegra LC like drug should be prescribed which contain a combination of Montelukast and Levocetirizine for at least a week.

According to your treating doctor's advise, get a visit done for physical examination and check your CBC.

Take care.

Hi,

Welcome back to icliniq.com.

For skin allergic reaction, Levocetirizine containing drug can be considered good because it is especially useful for skin allergy. Hence, a better prescription is Allegra LC, a combination of Montelukast and Levocetirizine. But if any side effect occurs like gastric upset, dizziness, headache, etc., then consult doctor nearby otherwise course can be completed for seven to ten days and repeat CBC. If no improvement then further workup needed according to examination.

You have been prescribed Rosuvastatin drug for high LDL (low-density lipoprotein). Remember this drug inhibitsmain pathway of lipid metabolism Hence, within one day your LDL value decreased. Once antilipidemic drug started, do not stop without doctor advise. If cholesterol value is within the limit, then 5 mg maintainance dose has to be taken. Your total cholesterol and triglycerides are within limit (attachment removed to protect patient identity). Hence, you should start with 5 mg Rosuvastatin as per my opinion rather than 10 mg.

Hi,

Welcome back to icliniq.com.

You can take the mentioned drug as it contains both Levocetirizine and Montelukast. It is the same drug available with a different brand name.

You are giving a history of use of hydrochlorothiazide diuretic drug intake. In some patient, this can lead hyperuricemia as a side effect. Hence, you have been prescribed Febuxostat drug that is effective in decreasing uric acid level below 5 to 6 within two weeks. As you do not have gout, I do not think you need a prophylactic treatment with Febuxostat for more duration. But, stop Febuxostat only after consultation with your treating doctor. So, until next consultation, please continue the prescribed drug.

Hello,

Welcome back to icliniq.com.

In polycythemia vera, high Hb, high RBC count and high PCV present usually. If only RBC mass elevated then you are right; hemoglobinopathy should be ruled out. For that Hb electrophoresis by HPLC method (high performance liquid chromatography) can be done. No, it is not necessary that WBC and platelet count should always be increased. Sometimes, only Hb, RBC, and PCV raised.

Hello,

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In hemolytic anemia, there is more need for RBC formation as a compensatory mechanism. From your HB electrophoresis report (attachment removed to protect patient identity), it seems to be HBD variant hemoglobinopathy (a form of hemolytic anemia). In this condition, folate can be low because of more erythropoiesis. But this condition is not life-threatening. Regular Hb should be checked, and if needed some medication can be prescribed. Your high RBC is because of hemoglobinopathy. Consult nearby physician or hematologist for physical examination and discuss your case. I hope your concern solved.

Hello,

Welcome back to icliniq.com.

It is not necessary that Hb always remain low in hemoglobinopathy. Hb can be within limit or borderline in many cases. So, if your Hb is within the limit, then it is good and no need to worry. A folic acid supplement can be prescribed in hemolytic anemia. HbE is a genetic defect that is transmitted from the parent. It is included in hemolytic anemia. Hemolytic anemia is a broad term. HbE is included in hemolytic anemia itself. Hbe Trait patient can live a healthy life without complications.

Hello,

Welcome back to icliniq.com.

At this moment I am trying to explain you further. In hemolytic anemia, RBC destruction occurs at around 15 to 20 days. The normal life span of RBC is 120 days, so here premature destruction occurs. So, body try to produce more RBC due to continous RBC destruction. That is called compensated hemolytic anemia. Thus, RBC is high. If the body cannot compensate for hemolytic anemia, then RBC remain low.

Hello,

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Stomach pain can be a referred pain. Rugae thickening is a benign condition for which tablet pantoprazole can be prescribed. I suggest you consult a gastroenterologist for evaluation of the rugae thickening. Also, biopsy and histopathology can be done to determine the cause. You must avoid spicy foods. If the pain persists, muscular or neurological causes should be ruled out. If the pain persists, I suggest you for NCV (nerve conduction velocity) and EMG (electromyography) done.

I hope this helps.

Take care.

Hello,

Welcome back to icliniq.com.

I have gone through the image (attachment removed to protect the patient's identity). The pointed area suggests a stomach issue, kidney stones, or intestinal causes of splenic pain. However, as your USG abdomen is normal, it is only a stomach issue. It can also be neuropathy or myositis. I suggest you consult a physician or gastroenterologist for a physical examination.

I hope this helps.

Thank you.