
Dr -- 1. Several Years Ago It Was Revealed That

1. several years ago it was revealed that my RBC was higher than normal & that i may suffer from moderate Sleep Apnea.
2. I did not want to use the CPAP machine. Instead I decided to lose some weight & went from 172 pounds to 159 pounds & my Sleep Apnea became very mild [if at all].
3. during this period i was under the care of a hematologist who tested my blood for several months/years. After some time, he released me because my RBC count was almost normal. My weight was 159 pounds when he released me.
4. my question is as follows – Now my weight has increased to 165 pounds. If my RBC counts continue to be slightly higher than normal -- then what is the likelihood that my high RBC count problem -- turns into some form of malignancy/cancer like polycythemia vera or secondary polycythemia? or something else of that nature?

1. several years ago it was revealed that my RBC was higher than normal & that i may suffer from moderate Sleep Apnea.
2. I did not want to use the CPAP machine. Instead I decided to lose some weight & went from 172 pounds to 159 pounds & my Sleep Apnea became very mild [if at all].
3. during this period i was under the care of a hematologist who tested my blood for several months/years. After some time, he released me because my RBC count was almost normal. My weight was 159 pounds when he released me.
4. my question is as follows – Now my weight has increased to 165 pounds. If my RBC counts continue to be slightly higher than normal -- then what is the likelihood that my high RBC count problem -- turns into some form of malignancy/cancer like polycythemia vera or secondary polycythemia? or something else of that nature?
CBC and PBS report needed for interpretations
Detailed Answer:
Hello,
Thanks for posting your query on 'Ask A Doctor' forum.
Elevated RBC count commonly occurs due to physiological causes like residing in high altitude areas.
In this case, hemoglobin is also slightly elevated.
I suggest you get a peripheral blood smear (PBS) examination also and upload the complete blood count (CBC) and PBS report for further information.
Polycythemia Vera is a neoplastic condition and is usually associated with symptoms of pruritis, headache, nose bleeds, etc.
In the absence of symptoms, polycythemia vera is unlikely.
However, if you are worried about the elevated TBC count you may get JAK 2 V617 mutation after consulting your hematologist.
Thanks and take care
Dr Shailja Puri

CBC and PBS report needed for interpretations
Detailed Answer:
Hello,
Thanks for posting your query on 'Ask A Doctor' forum.
Elevated RBC count commonly occurs due to physiological causes like residing in high altitude areas.
In this case, hemoglobin is also slightly elevated.
I suggest you get a peripheral blood smear (PBS) examination also and upload the complete blood count (CBC) and PBS report for further information.
Polycythemia Vera is a neoplastic condition and is usually associated with symptoms of pruritis, headache, nose bleeds, etc.
In the absence of symptoms, polycythemia vera is unlikely.
However, if you are worried about the elevated TBC count you may get JAK 2 V617 mutation after consulting your hematologist.
Thanks and take care
Dr Shailja Puri


I have sent you some lab results for your review:
1. 12/19/19: my most recent lab results
2. 6/15/18: CBC
3. 6/17/14: CBC
4. 6/2/14: JAK2 Mutations
Please let me know your thoughts. Thank you.

I have sent you some lab results for your review:
1. 12/19/19: my most recent lab results
2. 6/15/18: CBC
3. 6/17/14: CBC
4. 6/2/14: JAK2 Mutations
Please let me know your thoughts. Thank you.
Raised RBC count and hematocrit are likely to be physiological
Detailed Answer:
Hello and welcome again,
I have gone through all your laboratory reports.
The JAK 2 mutations are not detected and this rules out polycythemia vera for all practical purposes.
All other parameters - iron, ferritin and erythropoietin are also within normal range.
The RBC count and hematocrit are raised but it is likely to be physiological.
There is nothing to worry.
Thanks and take care
Dr Shailja Puri

Raised RBC count and hematocrit are likely to be physiological
Detailed Answer:
Hello and welcome again,
I have gone through all your laboratory reports.
The JAK 2 mutations are not detected and this rules out polycythemia vera for all practical purposes.
All other parameters - iron, ferritin and erythropoietin are also within normal range.
The RBC count and hematocrit are raised but it is likely to be physiological.
There is nothing to worry.
Thanks and take care
Dr Shailja Puri


1. Thank you for reviewing my medical records
2. In your expert opinion, over a long period of years, can chronically high RBC count and hematocrit -- turn into some form of malignancy/cancer like polycythemia vera or secondary polycythemia? or something else of that nature?

1. Thank you for reviewing my medical records
2. In your expert opinion, over a long period of years, can chronically high RBC count and hematocrit -- turn into some form of malignancy/cancer like polycythemia vera or secondary polycythemia? or something else of that nature?
Chances of polycythemia vera are negligible.
Detailed Answer:
Hello and welcome again.
Since all genes for polycythemia are not detected thus possibility of polycythemia vera is very low.
You can relax and can follow up RBC count and hematocrit with annual check ups.
RBC count is on higher side in people residing in high altitude areas.
Kindly, check at what altitude you are staying since that can be the cause of slightly higher TBC count and hematocrit.
Thanks and take care
Dr Shailja Puri

Chances of polycythemia vera are negligible.
Detailed Answer:
Hello and welcome again.
Since all genes for polycythemia are not detected thus possibility of polycythemia vera is very low.
You can relax and can follow up RBC count and hematocrit with annual check ups.
RBC count is on higher side in people residing in high altitude areas.
Kindly, check at what altitude you are staying since that can be the cause of slightly higher TBC count and hematocrit.
Thanks and take care
Dr Shailja Puri


1. I reside in a place with an altitude of 3700 feet above sea level. When i awaken after sleeping my eyes are often red -- which may indicate inadequate oxygen saturation while sleeping. I have been tested & the doctor indicates that i have fallen briefly below 90% oxygen saturation during sleep.
2. In your expert opinion, over a long period of years, can chronically high RBC count and hematocrit [due to altitude or low oxygen saturation] -- turn into secondary polycythemia?

1. I reside in a place with an altitude of 3700 feet above sea level. When i awaken after sleeping my eyes are often red -- which may indicate inadequate oxygen saturation while sleeping. I have been tested & the doctor indicates that i have fallen briefly below 90% oxygen saturation during sleep.
2. In your expert opinion, over a long period of years, can chronically high RBC count and hematocrit [due to altitude or low oxygen saturation] -- turn into secondary polycythemia?
Sleep apnea & low oxygen saturation is the probable cause of high RBC count
Detailed Answer:
Hello and welcome again,
As you have mentioned that you suffer from sleep apnea leading to low oxygen saturation.
Low oxygen saturation can be the cause of raised RBC count and hematocrit.
Altitute of 3700 feet is not very high so as to cause physiological polycythemia.
Physiological polycythemia dose not develop into polycythemia vera.
The cause of sleep apnea and low oxygen saturation needs to be found out and thus treated as this may be the cause of raised RBC count and raised hematocrit.
Thanks and take care
Dr Shailja Puri

Sleep apnea & low oxygen saturation is the probable cause of high RBC count
Detailed Answer:
Hello and welcome again,
As you have mentioned that you suffer from sleep apnea leading to low oxygen saturation.
Low oxygen saturation can be the cause of raised RBC count and hematocrit.
Altitute of 3700 feet is not very high so as to cause physiological polycythemia.
Physiological polycythemia dose not develop into polycythemia vera.
The cause of sleep apnea and low oxygen saturation needs to be found out and thus treated as this may be the cause of raised RBC count and raised hematocrit.
Thanks and take care
Dr Shailja Puri


1. my doctor has tested me & stated that my sleep apnea is very mild [if at all] -- especially when i sleep on my side & use a supportive pillow
2. also i have been unable to use the CPAP machine in the past -- because of discomfort
3. do you think that there are any concerns if the raised RBC count and raised hematocrit continue long term?
Thank you.

1. my doctor has tested me & stated that my sleep apnea is very mild [if at all] -- especially when i sleep on my side & use a supportive pillow
2. also i have been unable to use the CPAP machine in the past -- because of discomfort
3. do you think that there are any concerns if the raised RBC count and raised hematocrit continue long term?
Thank you.
There is nothing to worry about raised RBC count and raised hematocrit
Detailed Answer:
Hello and welcome again,
Keeping in view your history and investigations, there is nothing to worry about raised RBC count and raised hematocrit.
Thanks and take care
Dr Shailja Puri

There is nothing to worry about raised RBC count and raised hematocrit
Detailed Answer:
Hello and welcome again,
Keeping in view your history and investigations, there is nothing to worry about raised RBC count and raised hematocrit.
Thanks and take care
Dr Shailja Puri

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