Q. I have low vitamin B12 with high hemoglobin and high hematocrit. Is it polycythemia?

Answered by
Dr. Parth R Goswami
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 13, 2020 and last reviewed on: Mar 19, 2020

Hello doctor,

Last week I went to the doctor for several reasons like headche, weakness, tightness and pressure in the head and body pain. He ordered some blood work and chest x-ray. Doctor told me that chest x-ray report is good and he just told I have low vitamin B12 level and I have bacteria in stomach.

He prescribed me Omeprazole, Clarithromycin, and Amoxicillin and I took five shots of vitamin B12. But still, I feel tightness in the head and several headaches. My hemoglobin and hematocrit level is too high. My bowel habits is also changed. I pass stools right after eating three to four times a day. All my symptoms meet cancer. Do you think I have polycythemia or polycythemia vera? Do you want me to consult hematologists? Please give your opinion.



Welcome to the

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

You had a complaint of left side abdominal pain with a headache. Hence gastritis can be the possibility and for that antibiotic and antacid course are prescribed.

Sometimes upper gastrointestinal infection can lead to poor absorption of vitamin B12 and so deficiency can occur but here your B12 value is borderline in the report. So further work up can be done at that time by measuring homocysteine and methylmalonic acid measurement for confirming B12 deficiency.

Anyhow you completed the course of B12 injection so no need for measurement of homocysteine. Your stool frequency is increased and it seems to be stress-related irritable bowel syndrome (stress, anxiety lead headache as well).

Yoga, meditation, and exercise will be beneficial in reducing stress. Consume more fruits and green leafy vegetables.

If needed psychiatrist help can be taken. If stress and anxiety are not related then USG (ultrasound) abdomen or endoscopy like workup can be planned only if gastrointestinal symptoms worsening.

In your attached CBC report values are within limits. In polycythemia (which you are suspecting) Hb is greater than 17.5, WBC count and platelets also can be high, RBC values are high and HCT is more than 55% usually. So here polycythemia is not the possibility. Repeat CBC after completing your antibiotic course. Lack of sleep, hypoglycemia, smoking, stress, irregular meal habit, migraine, etc., are some other causes for headache.

I hope this helps.

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