Do you feel like you have too many red blood cells? Let's talk about erythrocytosis!

Do you sometimes just feel tired, have a headache, or feel weak? We often don't pay much attention to these little things, right? However, if the number of red blood cells in your body increases beyond the recommended level, which is what doctors call erythrocytosis or polycythemia , these symptoms may appear. This is something that you should be a little concerned about sometimes. So, today we will talk in detail about what erythrocytosis is, why it happens, and what can be done about it.

What exactly is erythrocytosis?

Simply put, Erythrocytosis is when your blood has a higher than normal concentration of Red Blood Cells (Erythrocytes). As you know, our blood is made up of two parts. One is the solid part, which is the red blood cells, white blood cells, and platelets. The other part is the liquid part, which we call plasma. In erythrocytosis, the number of red blood cells increases relative to the liquid part, which is the plasma.

If you get a blood test, you will see two values ​​on the report: Hematocrit and Hemoglobin .

• Hematocrit (HCT): This tells you what percentage of your blood is red blood cells.
• Hemoglobin (HB): This is a very important protein found inside red blood cells that carries oxygen throughout our bodies.

In erythrocytosis, either or both of these hematocrit and hemoglobin values ​​may be higher than normal.

How does this increase in red blood cells affect the body?

Red blood cells are essential for our bodies. They carry oxygen from the lungs to every cell and tissue in the body. This is why our tissues are nourished and healthy.

However, if these red blood cells increase too much, problems can occur. It depends on the reason for the increase in red blood cells. Some effects are very minor. You may only feel things like headaches and fatigue. However, if the red blood cells increase for some serious reasons, the blood starts to thicken. Then there is a risk of dangerous conditions such as blood clots, heart attack or stroke .

That's why, if you have such symptoms, it's very important to see a doctor to find out the exact cause. Only then can you get proper treatment, reduce symptoms, or prevent dangerous conditions.

What are the main types of erythrocytosis?

Erythrocytosis can be divided into two types depending on the way these red cells increase:

1. Absolute Erythrocytosis: This is when the number of red blood cells produced in your body is actually higher than normal.

2. Relative Erythrocytosis: This is when the red blood cell count may be normal, but the amount of plasma in the blood is reduced, so the red blood cell concentration appears to be increased. For example, if you vomit a lot and have diarrhea and lose a lot of water from your body, the fluidity of your blood decreases. This condition can occur at times like these.

Absolute Erythrocytosis is further divided into two types, depending on the cause:

Primary Erythrocytosis

The problem lies in our bone marrow. As you know, the bone marrow is the main factory in our body that makes red blood cells. So, in this primary erythrocytosis, due to a genetic defect in the stem cells (progenitor cells) in the bone marrow, the production of red blood cells increases uncontrollably. This genetic defect can be inherited (as a birth defect), or it can also occur during life.

• Acquired Primary Erythrocytosis: A good example of this is a condition called Polycythemia Vera . Many people confuse Erythrocytosis and Polycythemia Vera as the same disease. However, they are not the same. Polycythemia Vera is a specific and quite serious condition that causes Erythrocytosis.
• Inherited Primary Erythrocytosis: Sometimes, defects in genes inherited from parents can cause the bone marrow to produce too many red cells.

Secondary Erythrocytosis

The problem here is not in the bone marrow, but in something else outside the bone marrow. Most of the time, secondary erythrocytosis is caused by our body producing too much of a hormone called erythropoietin , or EPO . `EPO` is a chemical messenger. It's what tells the bone marrow to "make more red cells."

Imagine, you have a lung disease or a heart disease. Then the amount of oxygen that the body receives is low. At that time, the body tries to make more of the hormone `EPO`, and through it, stimulate the bone marrow to make more red cells. Because red cells carry oxygen. However, if the production of red cells in this way increases too much, it causes secondary erythrocytosis. This secondary erythrocytosis can also be caused by some genetic conditions, but those genetic defects are not those in the bone marrow.

How do you check blood values ​​to see if you have erythrocytosis?

In fact, the level of red blood cell concentration that is considered normal can vary from person to person. Many factors affect this, including your age, whether you are male or female, and the altitude of the area where you live (whether you are at sea level or in a mountainous area).

Erythrocytosis in adults is usually diagnosed by an increase in hematocrit (HCT) and/or hemoglobin (HB). These values ​​can be measured with a blood test called a ``Complete Blood Count (CBC)``.

For men:

• Hematocrit (HCT): If greater than 50%
• Hemoglobin (HB): If more than 17.5 g/dL

For non-pregnant women:

• Hematocrit (HCT): If greater than 45%
• Hemoglobin (HB): If more than 15.3 g/dL

Important: These values ​​are only a general guide. Your doctor will determine exactly whether you have erythrocytosis after considering your overall health.

What are the causes of Relative Erythrocytosis?

This is caused by a decrease in the amount of water in the body, which causes the blood's fluidity (plasma) to decrease and the concentration of red blood cells to increase. So, the main reason for this is dehydration .

• Severe vomiting
• Diarrhea
• Certain medications, for example, diuretics (medicines that remove water from the body) (These are given for high blood pressure or fluid retention).

Due to such reasons, the amount of fluid in the body can decrease and cause relative erythrocytosis.

What are the causes of Absolute Erythrocytosis?

There are two separate causes for this: primary and secondary.

Causes of primary erythrocytosis:

This is often caused by a genetic defect that affects the bone marrow.

• Polycythemia Vera and Other Myeloproliferative Neoplasms: These are conditions in which the bone marrow overproduces red blood cells and other blood cells. Polycythemia Vera is the most common of these.
• Birth defects: Some people may be born with a genetic defect that causes the bone marrow to produce too many red blood cells.

Causes of secondary erythrocytosis:

This is usually caused by an increase in the hormone `EPO`.

• Conditions that reduce oxygen to tissues:
• Lung Disease (e.g. chronic bronchitis, emphysema)
• Heart Disease (e.g. congenital heart defects)
• Sleep apnea
• Hemoglobinopathy: These are conditions in which the hemoglobin protein in red blood cells cannot carry oxygen properly due to a defect.
• Kidney diseases and transplants:
• Renal Artery Stenosis (narrowing of the blood vessels supplying the kidneys)
• Hydronephrosis (swelling of the kidneys due to accumulation of urine)
• This condition can sometimes occur even after a kidney transplant.
• Tumors: Some cancerous and non-cancerous tumors can secrete excess EPO hormone.
• Cancerous tumors: Renal Cell Carcinoma, Hemangioblastoma, Hepatocellular Carcinoma, Parathyroid Carcinoma.
• Non-cancerous tumors: Uterine Fibroids, Pheochromocytoma, Meningioma.
• Carbon monoxide poisoning and smoking: Heavy smoking can cause carbon monoxide poisoning, which can reduce oxygen to the tissues.
• Some medicines and drugs:
• Anabolic Steroids (taken by athletes to increase strength)
• Taking the hormone testosterone.

What symptoms might a person with erythrocytosis experience?

The symptoms you experience (and how severe they are) depend on the cause of your erythrocytosis. For example, someone with secondary erythrocytosis may experience symptoms like:

• Headache
• A confused state, a state of difficulty in concentrating
• Difficulty falling asleep
• Feeling weak, tired

A person with primary erythrocytosis (especially polycythemia vera) may experience more severe symptoms:

• High Blood Pressure
• Excessive sweating at night
• Weight loss for no reason
• Severe pain, swelling, and redness in the joints (also called gout )
• Bleeding problems (frequent nosebleeds, bleeding or bruising from even a minor injury)
• Itchy skin (itching may increase, especially after a hot bath)
• Numbness in the limbs, a feeling like ants are running around
• Redness with inflammation on the face, hands, and feet.

How do doctors diagnose erythrocytosis?

Your doctor will first try to determine the cause of your high red blood cell count, using a variety of tests and procedures.

First, they will ask questions about your medical history, the medications you take, your lifestyle (e.g., do you smoke), and your symptoms, and check for relative erythrocytosis (which is caused by a decrease in plasma in the blood). They will also perform a physical examination.

The next thing to check is whether you have primary or secondary . You can also do a few more tests with the information mentioned above.

What tests are being done?

• Complete Blood Count (CBC): This can check your red blood cell count, hemoglobin (HB), and hematocrit (HCT) levels.
• Peripheral Blood Smear (PBS): This involves taking a drop of blood and looking at the cells under a microscope to see if they are abnormal in shape or size. If you have a condition like Polycythemia Vera, you may see abnormal cells.
• Kidney and Liver Function Tests: This can give an idea of ​​whether there is kidney disease or a tumor that is making too much EPO.
• Pulse Oximetry: A small sensor placed on the finger measures the oxygen level in the blood. This can help determine if the condition is caused by things like heart disease or lung disease.
• Checking the level of erythropoietin (EPO): If the level of `EPO` is low, it may be primary erythrocytosis, if the level of `EPO` is high, it may be secondary erythrocytosis.
• Urinalysis: A urine sample is taken to check for abnormalities. If there are red cells in the urine, it may be due to kidney disease.

If the doctor suspects a specific condition, such as polycythemia vera, he or she may also perform other tests, such as a bone marrow biopsy .

How is erythrocytosis treated?

In most cases, the cause of erythrocytosis cannot be completely cured. However, treatment can control and reduce symptoms. In cases of erythrocytosis caused by serious causes, treatment is also used to prevent dangerous conditions such as blood clots.

• Phlebotomy or Venesection:

This is the most common treatment for polycythemia vera. It's like donating blood, but it involves taking a small amount of blood from a vein and reducing the number of red blood cells and blood volume that are too high. Secondary erythrocytosis often doesn't require this treatment.

• Medications:
• For people at high risk of blood clots, a doctor may recommend taking a low-dose aspirin daily.
• There are also medications that reduce red blood cell count:
• Hydroxycarbamide `(Hydroxycarbamide)`
• Hydroxyurea `(Hydroxyurea)`
• Busulfan
• Interferon alfa `(Interferon alfa)`
• Ruxolitinib

Your doctor will prescribe medications that are appropriate for your condition. They will also prescribe treatment for the underlying condition, depending on the underlying cause of your erythrocytosis.

If I have this condition, what should I expect?

Your experience will depend on the cause of your erythrocytosis and how severe it is. For example, some hereditary conditions of primary erythrocytosis cause only mild symptoms and are not life-threatening. However, more serious conditions, such as polycythemia vera, may require lifelong treatment.

How do I take care of myself?

The most important thing is to follow your doctor's instructions exactly. In the meantime, there are a few lifestyle changes that may help you:

• If you smoke, stop it.
• Maintain a healthy body weight.
• If you have high blood pressure, control it.
• Avoid traveling from sea level to very high altitudes (mountainous areas) as much as possible.

When should I go to a hospital urgently (ETU) ?

If you have a condition related to erythrocytosis that puts you at risk for blood clots, it's important to be aware of the symptoms of a blood clot. If you experience any of the following symptoms, seek medical attention immediately:

• Deep Vein Thrombosis (DVT): Swelling, pain, and redness in one leg.
• Blood clot in the lungs (Pulmonary Embolism - PE): Chest pain, difficulty breathing, feeling dizzy.
• Stroke: Sudden loss of balance, coordination, muscle weakness or numbness on one side of the body.
• Heart Attack: Chest pain, shortness of breath, feeling dizzy, sweating.

If you have any of these symptoms, please see a doctor immediately without delay.

Finally, things to remember (Take-Home Message)

Erythrocytosis is an increase in the number of red blood cells in your blood. This can be a minor condition, or it can sometimes be a sign of a serious condition.

• If you have any unusual symptoms (especially persistent fatigue, headache, skin rash, difficulty breathing), see a doctor.
• The doctor will determine the exact cause of your high red blood cell count.
• Sometimes, simple lifestyle changes (e.g., reducing the amount of medication you take, treating dehydration) can resolve this problem.
• If erythrocytosis is caused by a more serious condition, your doctor will monitor you regularly and provide you with the necessary treatment.

Taking care of your health is very important, so if you have any concerns, don't be afraid to talk to a doctor.

` Erythrocytosis, polycythemia, red blood cells, hemoglobin, hematocrit, blood clotting, bone marrow