Q: I am a 41 years old married man. During my last medical check-up (one and a half year back), my haemoglobin level was recorded as 17+. The medical report highlighted it as being above the normal level. When I enquired with a cardiologist, he said its not very high, but slightly higher. He said it was normal and that there was nothing to worry about. My blood sugar and cholestrol was absolutely normal. Whereas I have moderate hypertension for the last three years for which Im taking Telme 20 as per the advice of my doctor. I'm a healthy person and I don't have any health problem. I request your expert advice on the following: - What is the normal level of haemoglobin one should have and what is the maximum level? - If my haemoglobin level is more than the normal level, how can I control it? What is the implication of high level of haemoglobin? What is the reason for higher level of haemoglobin ? - Is there any specific food which can control haemoglobin or are there any foods which I should avoid? - Is there any risk if the haemoglobin level is more than the normal level?

A: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 have higher values than adults. The presence of an elevated red cell count is called erythrocytosis or a polycythaemia. 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. Red blood cell production is governed by a hormone called erythropoietin (EPO) that is secreted by the kidney. Erythrocytosis is not a disease but is usually part of some other problem. There are no specific symptoms or physical signs although the underlying disease may cause the patient to seek medical help. Many times, the high hematocrit is noticed when a person has a blood count done as part of an exam for an unrelated complaint. 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) a true or absolute erythrocytosis (polycythemia) due to an increase in red cells or b) an apparent or secondary 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 polycythemia may be primary and is then called polycythemia vera, a myeloproliferative disorder in which the RBC count increases without being stimulated by the red blood cell stimulating hormone erythropoietin. This is a bone marrow disorder in which there is unregulated red cell production. Secondary polycythemia 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 haemoglobin or an overproduction of erythropoietin; and diseases such as kidney disease. Symptoms of polycythemia 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 tolerance, weight loss, and itching. The usual investigations undertaken include a complete blood count with peripheral smear examination, estimation of arterial oxygen saturation, serum erythropoietin level and red cell mass (rarely done) and a bone marrow examination. If an underlying problem is found, it can usually be corrected, and the erythrocytosis should disappear. If there is not a correctable problem, then further management depends on how high the hematocrit is. If the haematocrit is just a little above normal, perhaps nothing needs to be done. However, if the hematocrit gets too high (above 60 percent), it thickens the blood, causing circulatory difficulties that may result in strokes and heart problems. To avoid these problems, the patient can have phlebotomies (blood-letting) to reduce the hematocrit. One unit of blood can be removed every few days or once a week until the haematocrit is down and then done at intervals of time to keep it down. Phlebotomy is quite like donating blood. You can discuss this with your doctor or consult a haematologist who can then examine and investigate you and advise appropriately.