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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What is the treatment for polycythemia?

The treatment for polycythemia is generally dependent on the cause.

In polycythemia vera or other primary polycythemia syndromes, the treatment options are more specific. Phlebotomy (drawing blood or blood letting) is the most essential part of the treatment. The recommended hematocrit of less than 45 in men and less than 42 in women is the goal of phlebotomy.

Several medications have been considered in conjunction with phlebotomy to suppress the abnormal production of red blood cells. Most of these chemotherapeutic drugs have been linked with side effects and their use has been controversial and limited.

The medication hydroxyurea (Hydrea) has been recommended for some patients with primary polycythemia and higher risk of blood clot formation due to high blood viscosity. The factors favoring treatment with hydroxyurea are age greater than 70, platelet count greater than 1.5 million, and general cardiovascular risk factors.

Aspirin and other anti-platelet agents (dipyridamole [Persantine]) may also be beneficial in patients with polycythemia by reducing clotting complications, unless the patient has a history of bleeding problems.

In patients with secondary polycythemia, the goal is to treat the underlying condition. For example, in patients with lung or heart disease with hypoxia, appropriate management of these conditions along with oxygen supplementation is generally advised.

What are the complications of polycythemia?

Potential complications of polycythemia vera is increased levels of circulating red blood cells, which increases the thickness or viscosity of the blood. This can be associated with higher risk of thrombus or clot formation leading to strokes, heart attacks, pulmonary embolism, and possibly death.

Another complication of polycythemia vera is the potential transformation into a blood cancer (leukemia), excessive bleeding (hemorrhage), or clotting problems.

Because of high turnover of blood cells in polycythemia, the excretion of the byproducts of red blood cell degradation may over burden the kidneys and result in kidney dysfunction, kidney stones, and gout.

Finally, there is the potential for myelofibrosis (spent marrow), in which the blood-forming marrow elements are eventually taken over by scar tissue resulting in anemia from marrow failure.

Complications of secondary polycythemia are typically related to those of the underlying disease. For example, chronic hypoxia from severe lung disease may be complicated by right sided heart failure and pulmonary hypertension. Chronic heart failure can lead to generalized swelling or edema (anasarca), low blood pressure, kidney dysfunction, and poor functional status.

In neonatal (infant) polycythemia, increased blood thickness or viscosity can affect several organs due to poor blood flow. As a result, kidney dysfunction, intestinal problems, increased blood pressure in the lungs, and hypoxia may ensue.

Medically Reviewed by a Doctor on 2/23/2016

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