Polycythemia (Elevated Red Blood Cell Count)

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Polycythemia facts

  • Polycythemia means increased red blood cell volume.
  • Polycythemia is divided into two main categories; primary and secondary.
  • Polycythemia can be linked to secondary causes, such as, chronic hypoxia or tumors releasing erythropoietin.
  • Polycythemia vera is due to abnormally increased red cell production in the bone marrow.
  • Treatment of secondary polycythemia is dependent on the underlying condition.
  • Polycythemia is treated by phlebotomy (controlled blood letting) and hydroxyurea.

What is polycythemia?

Polycythemia is a condition that results in an increased level of circulating red blood cells in the bloodstream. People with polycythemia have an increase in hematocrit, hemoglobin, or red blood cell count above the normal limits.

Polycythemia is normally reported in terms of increased hematocrit (hematocrit is the ratio of the volume of red blood cells to the total volume of blood) or hemoglobin concentration (hemoglobin is a protein responsible for transporting oxygen in the blood).

  • Hematocrit (HCT): Polycythemia is considered when the hematocrit is greater than 48% in women and 52% in men.
  • Hemoglobin (HGB): Polycythemia is considered when a hemoglobin level of greater than 16.5g/dL in women or hemoglobin level greater than18.5 g/dL in men.

Polycythemia can be divided into two categories; primary and secondary.

  • Primary polycythemia: In primary polycythemia the increase in red blood cells is due to inherent problems in the process of red blood cell production.
  • Secondary polycythemia: Secondary polycythemia generally occurs as a response to other factors or underlying conditions that promote red blood cell production.

Red cell production (erythropoiesis) takes place in the bone marrow through a complex sequence of tightly regulated steps. The main regulator of the red cell production is the hormone erythropoietin (EPO). This hormone is largely secreted by the kidneys, although, about 10% may be produced and secreted by the liver.

Erythropoietin secretion is up-regulated in response to low oxygen levels (hypoxia) in the blood. More oxygen can be carried to tissues when erythropoietin stimulates red blood cell production in the bone marrow to compensate for the hypoxia.

Neonatal (newborn) polycythemia can be seen in 1% to 5% of newborns. The most common causes may be related to transfusion of blood, transfer of placental blood to the infant after delivery, or chronic inadequate oxygenation of the fetus (intrauterine hypoxia) due to placental insufficiency.

Medically Reviewed by a Doctor on 2/23/2016

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