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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Can other sources of erythropoietin (EPO) cause polycythemia?

Erythropoietin (EPO) has been made synthetically for clinical treatment of certain types of anemia. Some professional athletes have used this type of injectable EPO (blood doping) to improve their performance in competitions by producing more hemoglobin and, therefore, improving the delivery of oxygen to their tissues, mainly muscles. This type of doping practice is banned by many professional sport committees.

What is relative polycythemia?

In some forms of secondary polycythemia, the hemoglobin or red blood cell count is perceived to be abnormally high due to an increased concentration of blood. This can happen as a result of plasma volume loss from dehydration, severe vomiting or diarrhea, or excessive sweating. Polycythemia in these situations may be called relative polycythemia, because the actual numbers of red blood cells are not abnormal.

What are the risk factors for polycythemia?

  • Hypoxia from long standing (chronic) lung disease and smoking are common causes of polycythemia. Therefore, smoking can be significant risk factor for polycythemia.
  • Chronic carbon monoxide (CO) exposure can also be risk factor for polycythemia. Hemoglobin has a higher affinity for CO than for oxygen; therefore, as it replaces oxygen in favor of CO, polycythemia may ensue to compensate for the low oxygen carried by hemoglobin.
  • Chronic carbon monoxide exposure is a risk factor for people working in underground tunnels or parking garages, cab drivers in highly polluted and congested cities, or workers in factories with exposure to engine exhaust.
  • People living at high altitudes may also be at risk of developing polycythemia due to low environmental oxygen levels.
  • People with genetic mutations and familial types of polycythemia and certain hemoglobin abnormalities also carry risk factors for this condition as mentioned in earlier sections.

What is stress polycythemia?

Stress polycythemia is a term applied to a chronic (long standing) state of low plasma volume which is seen commonly in active, hard working, anxious, middle-aged men. In these people, the red blood cell volume is normal, but the plasma volume is low. This condition is also known as Gaisbock's disease, stress erythrocytosis, or pseudopolycythemia.

Smoker's polycythemia is a similar condition in which increased levels of deoxygenated hemoglobin (hemoglobin that does not carry oxygen, instead carrying carbon dioxide) causes an increase in red blood cell counts.

Medically Reviewed by a Doctor on 2/23/2016

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