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I am suffering from hypertension since few years, and I am currently on medication Telmisartan. I am an alcoholic and smoker, and I smoke approximately 15 cigarettes a day for the last five years. My current CBC report suggests high RBC, hemoglobin, and PCV. Though it reduced slightly from last year, it is still high. From the past 15 days, I completely quit alcohol and cigarette. Will the RBC, hemoglobin, and PCV come back to normal? If so, how much time will it take approximately? Last year, my hemoglobin was 20.1 g/dL, but now it is 17.4 g/dL, PCV is 55, and RBC is 6.72. Please help and suggest some treatment. Will it ever be normal? I have attached my reports.
I have gone through your attached reports (attachment removed to protect patient identity).
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.
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.
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.
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 have attached chest x-ray and echocardiogram reports. I also did LFT and KFT, which were normal, except my sodium is a little low. I do not have diabetes or thyroid. If it is the case of polycythemia due to smoking, will it come back to normal after quitting? If yes, how long will it take? Is hemoglobin level of 17.4 g/dL very high?
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.
I hope you remember me. I was a heavy smoker and alcoholic and have quitted now almost a month. Please see the previous report of CBC, which was done around eight months back. Today again I did a CBC test, and the results showed some improvements such as Hb 17.4 came down to 16.8, PCV 55.10 got reduced to 52.8 and RBC count decreased from 6.7 to 6.5. Still, do you think I have polycythemia secondary? Will it improve further abstaining from smoking? What is your opinion about my case? Is phlebotomy required due to high RBC count? But, my eosinophils rose to 11. 8. What could be the reason and hot to treat it? I am itching on my skin as of now.
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.
Skin examination, as the skin will be rudy and thick in primary polycythemia.
Liver, Spleen palpation because most of the case of primary polycythemia have splenomegaly.
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.
My report says TLC 10.3, platelets 197 now and before two weeks it was 214. I had my USG before two months, and there was no splenomegaly. Please see the report. May I know your opinion now? Does Hb 16.8 suggest polycythemia? Will it heal over time since there is one-month abstinence from smoking? What do you like to recommend for high eosinophilia?
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.
Thanks a lot. For high eosinophilia and itching, should I take Montelukast plus Levocetirizine or Montelukast plus Fexofenadine? And, please see my lipid profile test attached. My LDL was 105 and doctor suggested Razel 10. Today, I checked my LDL, and it got reduced to 49.60. Shall I stop Razel or Should I continue taking it? Is LDL 49.60 dangerously low? What should be the ideal value?
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.
Instead of Allegra LC, I got L Hist Mont (Levocetirizine dihydrochloride plus Montelukast). Can I take that? My uric acid was elevated two weeks back to 8.7 as I was given Telmisartan hydrochlorothiazide later hydrochlorothiazide was withdrawn, and Telma AM was suggested. I was on Febutaz 40, and now my uric acid came to 4.7. Should I continue Febutaz 40? I do not have either knee or joint pain, but slight heel pain in one leg.
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 don't 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.
Does only RBC elevate in polycythemia vera or all the three components that are Hb, PCV and RBC count? If Hb, PCV normal and RBC count raised, does it mean polycythemia vera? What could be the reason if only RBC elevated and not HB PCV? Is it compulsory that in PCV, WBC and platelets will also increase?
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.
Please go through the report. Does the report reveal the reason why RBC has elevated always with normal Hb and PCV? I also have low MCV, low MCH and near normal MCHC. I also have low folate levels. Is there any treatment for this? Can I live a normal life expectancy?
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. Hope your concern solved.
I understood my case is HbE trait and hemolytic anemia. Is that two a different form? What medicine is prescribed in this case? In general, how will be the Hb of a person with HbE trait and hemolytic anemia, either low or average? My Hb is always 14 to 16 range. Before nine years, it was 15 with normal PCV and high RBC.
My mom was HbE, and HbA2 was 28 %, but she had low Hb. I too have the same condition, but my Hb is in the normal range. Why? Is having normal Hb in my case abnormal?
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.
In hemolytic anemia, there is a premature destruction of red blood cell. And, bone marrow cannot make enough RBC fast enough to meet body's needs. But in my case, there is an overproduction of RBC. Why? Does hemolytic anemia mean low or high RBC? I do not have iron or TIBC deficiency.
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.
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