Do you have too many red blood cells in your blood? Let's talk about erythrocytosis.

Have you ever had a full blood count and noticed that the number of red blood cells (RBC) in the report was slightly higher than normal? It's normal to feel a little nervous and scared when you see something like that. "What is this? Why is this happening?" You might think. In medicine, when the number of red blood cells in the blood is higher than normal, we call it erythrocytosis. Don't worry, we'll talk about this clearly and simply today.

First, let's see, what are these red blood cells?

Simply put, red blood cells are like little workers in our blood. Their main job is to collect oxygen that comes into the lungs when we breathe and carry it to the cells in every corner of the body . They also help bring carbon dioxide that is released from the cells back to the lungs and get rid of it when we breathe out. These little workers are produced in our bone marrow. There, they are formed, join the blood, do their job for about 120 days, and then die. This cycle happens constantly. However, if for some reason, the production of these red blood cells increases too much, that is where the condition called Erythrocytosis occurs.

There are two main types of erythrocytosis:

This increase in red blood cells can occur in two main ways. Although both cases involve an increase in red blood cells, the cause is different.

Why do red blood cells increase like this? What are the reasons?

The reason varies depending on the type we talked about earlier.

Causes of Primary Erythrocytosis

Sometimes this can be a harmless genetic condition that is passed down through generations. If you have only too many red blood cells in your blood, and your white blood cells and platelets are normal, this could be the cause. However, sometimes this is caused by a type of blood cancer called polycythemia vera . Now, don't be scared when you hear the word "cancer." This is a very slow-growing, rare condition . Some people don't even know they have it for years. But it can be dangerous if left untreated. Because when red blood cells increase, the blood thickens and the flow decreases. This increases the risk of blood clots .

Causes of Secondary Erythrocytosis

There can be many reasons for this. The main reason is low oxygen levels in the body. Oxygen levels may decrease:

• Smoking : Smoking damages the lungs and reduces the body's ability to take in oxygen.
• Heart problems and lung disease: Conditions like asthma and COPD can cause low oxygen levels.
• Sleep Apnea: This is when breathing stops or becomes shallow during sleep at night. This also reduces the amount of oxygen the body receives.
• Living in high altitudes: Imagine that when you go to a high altitude area like Nuwara Eliya, some people feel difficulty breathing. This is because the oxygen concentration in the air is low. When you live in such areas for a long time, the body increases the production of red blood cells to adapt to it.
• Hemoglobinopathy: This is an inherited blood disorder in which red blood cells are unable to properly carry oxygen.

Other reasons:

• Kidney disease : The EPO hormone we talked about earlier is produced in the kidneys. So problems like kidney cysts, tumors, or narrowing of the blood vessels that supply the kidneys can cause excess production of the EPO hormone.
• Certain medications: Some bodybuilding medications, such as anabolic steroids, can increase red blood cell production.
• Tumors: Some tumors that develop in organs such as the kidneys, brain, liver, and uterus can secrete the EPO hormone.
• Dehydration: Sometimes the red blood cell count is not actually high. But the amount of water (fluidity) in the body has decreased and the blood has become thick. Then a blood test shows an increased red blood cell concentration. This can be caused by things like diarrhea, vomiting, burns, or not drinking enough water.

What are the symptoms of this condition?

Many symptoms occur because the blood thickens and slows down its movement throughout the body. Not everyone will experience all of these symptoms. Some people may not have any symptoms at all.

• Headache
• Blurred vision
• Confusion
• High blood pressure
• Nosebleeds
• Itchy skin (especially after bathing in hot water)
• Weakness and Tiredness

If you have symptoms like these, it is very important to talk to your doctor about it.

How does a doctor find this?

This condition is usually first detected with a blood test. Your doctor will check your red blood cell count and your EPO hormone levels.

• If EPO levels are low: Further tests are done to look for Primary Erythrocytosis (especially Polycythemia Vera), as the problem may be in the bone marrow.
• If the EPO level is normal or high: Since the problem is elsewhere, tests are done to look for things that could be causing secondary erythrocytosis (lungs, heart, kidneys, etc.).

What are the treatments for this?

Treatment depends on the cause.

• For Primary Erythrocytosis (Polycythemia Vera): The main treatment is phlebotomy . This involves removing a small amount of blood from the body, similar to a blood transfusion. This removes excess red blood cells, thins the blood, and improves blood flow. Sometimes, medications may be given to prevent blood clots.
• For Secondary Erythrocytosis: The underlying cause is treated .
• Providing oxygen to those with low oxygen levels.
• If you are a smoker, provide advice and help to quit.
• Proper treatment of conditions such as heart disease and lung disease.
• If it is due to a cancerous tumor, surgically removing it.
• If it is due to a medication, discontinue or change the medication as directed by your doctor.
• If due to dehydration, give saline (fluids).

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