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Are high levels of RBC and haemoglobin a cause of worry?

Q: My husband recently underwent a medical check up. The report says that his RBC count is 6.52 m/c, haemoglobin is 18.9 gm/dl, pus cells 4-8/hpf and S. cholesterol is 209 mg/dl. His pulse rate is 88/mt and blood pressure is 130/80. He weighs 71 kg, and is 170 cm tall. What if his haemoglobin count increases? Should it be reduced? If yes, how? Recently we did a bone densitometry, in which his BMD is 0.382 and T-SCORE is-1.8. Is there something to worry? What should be done next?

A:It is important to remember that one treats an individual and not an abnormal test result. The number of red cells normally present varies according to a persons age and sex. Men have higher results than women do and newborn babies often have higher values than adults. The presence of an elevated red cell count is called erythrocytosis. This increase in red cells may show in a blood test result as an increase in red cell number, or as a rise in haemoglobin, or packed cell volume. The normal haemoglobin value in an adult male can range upto 18 g/dl. It can be raised due to many reasons and these causes may be subdivided into whether there is a true or absolute erythrocytosis (polycythaemia) due to an increase in red cells or an apparent erythrocytosis when the red cells are not increased but are instead more concentrated. The secondary increase can be due to dehydration, diuretic drugs, burns, stress, or high blood pressure. True polycythaemia may be primary and is then called polycythaemia vera, a myeloproliferative disorder in which the RBC count increases without being stimulated by the red blood cell stimulating hormone erythropoietin. Secondary polycythaemia is due to an increase in RBC counts following an increase in the hormone erythropoietin. This hormone increase is in response to low blood oxygen, caused by heart disease or high altitude; continual exposure to carbon monoxide (heavy smoking); chronic lung disease, congenital (hereditary) disorders producing an abnormal hemoglobin or an overproduction of EPO; and kidney disease. Symptoms of polycythaemia include easy bruisability, purpuric spots on skin, blood in the stool, blood clots, painful redness of the skin & warmth in parts of the limbs, blackening of the fingers or toes (necrosis), fever, heat intolerance, weight loss, and itching. You have not mentioned why the bone densitometry was done. It is usually indicated in patients with risk factors or conditions that cause osteoporosis like a) Postmenopausal women with family history of hip fractures or kyphosis b) Patients on medicines like corticosteroids, dilantin, gonadotropin releasing hormone agonists, loop diuretics, methotrexate, thyroid, heparin, cyclosporin etc. c) Hereditary skeletal diseases - osteogenesis imperfecta, rickets, hypophosphatasia d) Endocrine and metabolic disorders - hypogonadism, hyperparathyroidism, hyperthyroidism, Cushing syndrome e) Malabsorption f) Marrow diseases - myeloma, mastocytosis, thalassaemia g) Renal insufficiency etc. If your husband has no symptoms there is no need to worry.

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