Doctor Answers (4) on High hematocrit
●Hematocrit – The hematocrit (HCT) is expressed as the percent of a blood sample occupied by intact RBC. Polycythemia in the adult patient is considered to be present when the HCT is >48 or >52 percent in women and men, respectively.
●Hemoglobin concentration – The hemoglobin concentration (HGB) is expressed in grams per 100 mL of whole blood or in grams per liter of whole blood. Polycythemia in the adult is considered to be present when the HGB is >16.5 or >18.5 g/dL, or >165 or >185 g/L in women and men, respectively.
Red blood cell count – The red blood cell (RBC) count is expressed as the number of RBC per microL or liter of whole blood. The normal RBC count is approximately 5 x 106 cells per microL or 5 x 1012 cells per L. It is the least often used of the three tests to suggest polycythemia, since patients with thalassemia minor may have an elevated RBC count, but a reduced HCT or HGB due to the presence of an increased number of small (microcytic), poorly hemoglobinized (hypochromic) red cells.
TERMINOLOGY — The three measurements listed above (red blood cell [RBC] count, hemoglobin [HGB], and hematocrit [HCT]) are concentrations and therefore dependent upon the plasma volume as well as the RBC mass (RCM).
Relative polycythemia — An isolated decrease in plasma volume can elevate the HGB, HCT, and RBC count. The state of chronically reduced plasma volume with elevated HGB or HCT has been called Gaisbock's disease, spurious polycythemia, stress erythrocytosis, apparent polycythemia, and pseudopolycythemia , although many may be examples of smokers' polycythemia .
Absolute polycythemia — In absolute polycythemia (erythrocytosis) there is an increased RCM. Patients are further categorized into primary and secondary forms.
Primary polycythemia — Primary polycythemia is caused by an acquired or inherited mutation leading to an abnormality within RBC progenitors; it includes polycythemia vera (PV) and rare familial variants (eg, activating mutations of the erythropoietin receptor, Chuvash polycythemia).
Idiopathic erythrocytosis has been used to categorize patients with primary polycythemia who do not fulfill conventional criteria for the diagnosis of PV , including negativity for the exon 14 and exon 12 JAK2 mutations .
Secondary polycythemia — Secondary polycythemia is caused by a circulating factor stimulating erythropoiesis, usually erythropoietin (Epo). It is most often due to an Epo response to hypoxia, but can also result from an Epo-secreting tumor.
Combined polycythemia — Patients may have an increased RCM as well as a reduced plasma volume, a combination most commonly seen in smokers (ie, "smokers' polycythemia").
Inapparent polycythemia — If the RCM and plasma volume are equally increased, HGB, HCT, and RBC count remain normal.
An accurate history is critical. The most common cause of polycythemia is hypoxia secondary to pulmonary disease; as a result, eliciting symptoms pertaining to altered lung function is of paramount importance.
●Symptoms due to the underlying polycythemia are related to the increased viscosity of blood (hyperviscosity) and may include any or all of the following: chest and abdominal pain, myalgia and weakness, fatigue, headache, blurred vision, transient loss of vision, paresthesias, slow mentationand/or a sense of depersonalization.
●Symptoms suggesting the presence of underlying pulmonary disease include shortness of breath, dyspnea on exertion, chronic cough, history of cyanosis, and hypersomnolence with unintentional sleep.
●Symptoms suggesting the diagnosis of polycythemia vera (PV) include post-bath pruritus, erythromelalgia, gout, arterial or venous thromboses, hemorrhage, and early satiety due to the presence of splenomegaly.
Autonomous (inappropriate) increase of Epo - inappropriately high serum EpoErythropoietin-producing neoplasms (most common)Renal cell carcinomaHepatocellular carcinomaCerebellar hemangioblastomaPheochromocytomaUterine fibroidsErythropoietin-producing renal lesions (eg, cysts, hydronephrosis, renal artery stenosis, distal renal tubular acidosis [rare])Following renal transplantation (some cases are independent of erythropoietin)Appropriate increases in erythropoietin - appropriately high serum erythropoietinHypoxemia secondary to:Chronic pulmonary diseaseRight-to-left cardiac shuntsSleep apneaMassive obesity (Pickwickian syndrome)High altitudeRed cell defectsSome cases of congenital methemoglobinemiaChronic carbon monoxide poisoning (including heavy smoking)CobaltGermline and somatic mutational causes of polycythemiaPolycythemia vera (JAK2 mutation)Activating mutations of the erythropoietin receptor (EPOR gene)Chuvash polycythemia (VHL gene mutation)Congenital methemoglobinemiaIdiopathic familial polycythemiaHigh oxygen affinity hemoglobins2,3 bisphosphoglycerate (BPG) mutase deficiencyOther rare gene mutations (eg, PHD2, HIF2-alpha)Miscellaneous causesUse of androgens or anabolic steroidsDiuretics (reduced plasma volume rather than erythrocytosis)Blood doping in athletes (ie, autologous blood transfusion)Self-injection of erythropoietinPOEMS syndrome
Well your hb is normal only I don't think it is causing the breathlessness you are talking about ..I think you need to see a physician and get yourself examined and evaluated for te shortness of breath....ate you over weight..that might also be a reason....thank you