Q: My 65 years old father has raised liver enzymes and his liver is palpable. Haematocrit value is 63%, haemoglobin is 20 and total bilirubin is 4 mg/dl. He is experiencing headache and vomiting. Earlier his blood pressure was 100/70 mm/hg but now it is 150/100 mm/hg. What is polycythaemia? How is it related to bilirubin level, liver enzymes and blood pressure?

A:Polycythaemia is a condition of the bone marrow when there is an increase in the production of the Red Blood Cells (RBCs). As you may know the RBCs carry oxygen to all parts of the body. Their life span is about 120 days after which they get destroyed in the spleen and new cells produced take on the job and this is a continuous process. When the RBCs break down in the spleen and to a lesser extent in the liver, the released carrier pigment gets broken down by liver cells and excreted in the urine. In polycythaemia the liver has to handle far too many red cells which in turn may affect the efficiency of the cells, which when damaged release specific enzymes which can be detected by testing the blood for liver functions. These liver specific enzymes are ALT and AST (also known as SGOT and SGPT). The liver and spleen enlarge because of the excess workload. The condition can be primary or secondary to congenital heart disease or chronic lung disease where oxygenation in the lungs is inadequate. If the liver enzymes have gone abnormal it needs investigations and I suggest you consult a liver specialist as further investigations are indicated.