Elevated Erythrocytes and Hemoglobin: Understanding the Causes, Symptoms, and the Role of Polycythemia Vera (PV)

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An elevated number of erythrocytes (red blood cells or RBCs) and hemoglobin in the blood can indicate a condition known as polycythemia, or more specifically, polyglobulia. While this can be a temporary and benign finding, it may also be a sign of a more serious underlying health issue — particularly a bone marrow disorder such as Polycythemia Vera (PV).

In this article, we explore what elevated RBC and hemoglobin levels mean, what can cause them, and how PV fits into the picture.

What Is an Elevated RBC Count?

Red blood cells (erythrocytes) play a crucial role in transporting oxygen from the lungs to the body’s tissues. Hemoglobin, the iron-containing protein in RBCs, is responsible for binding to and carrying oxygen.

Normal RBC Count

In a healthy person, the RBC count typically falls within a specific range, usually measured in millions of cells per microliter (million/µL) of blood. These ranges vary slightly based on age, sex, and laboratory standards.

An RBC count is considered elevated when it exceeds the upper limit of this reference range. This condition is referred to as erythrocytosis or polycythemia.

Common Causes of Elevated RBC and Hemoglobin

Several physiological and environmental factors can lead to an elevated red blood cell count:

1. Dehydration

When the body loses fluid due to sweating, vomiting, or diarrhea, the plasma volume in the blood decreases. This causes the RBC concentration to rise relatively, even though the absolute number of cells may not have increased.

2. Chronic Oxygen Deficiency

Conditions such as chronic lung or heart diseases reduce oxygen levels in the body. In response, the body produces more RBCs to compensate:

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Congenital heart disease

  • Sleep apnea

3. Smoking

Heavy smoking can cause chronic low oxygen levels in the blood (hypoxia), which stimulates the bone marrow to produce more RBCs.

4. High Altitude

Living or spending time at high elevations exposes the body to lower oxygen levels, triggering increased red blood cell production.

Here's an Explanation of an Elevated RBC Count and Its Association with PV:

While the above causes are considered secondary erythrocytosis (due to external factors like hypoxia), there are also primary causes — the most notable being Polycythemia Vera (PV).

Polycythemia Vera (PV)

PV is a chronic myeloproliferative neoplasm (MPN) — a blood disorder in which the bone marrow produces too many blood cells, particularly RBCs, but also sometimes white blood cells and platelets.

The excess of red blood cells thickens the blood, slowing its flow and increasing the risk of blood clots, strokes, and heart attacks.

Key Characteristics:

  • PV is not caused by oxygen deficiency.

  • It is usually linked to a genetic mutation (commonly JAK2 V617F) that causes uncontrolled blood cell production.

  • PV is a rare but serious condition that requires long-term monitoring and treatment.

Symptoms of PV and Elevated RBC Count

Many people with elevated RBCs or PV may be asymptomatic at first, but as the condition progresses, they may experience:

Neurological and Circulatory Symptoms:

  • Fatigue and weakness

  • Headaches

  • Dizziness and lightheadedness

  • Blurred vision

  • Tinnitus (ringing in the ears)

  • Shortness of breath

  • Facial redness or flushed skin (plethora)

Skin Symptoms:

  • Itching, especially after warm baths or showers

  • Excessive sweating, particularly at night

Vascular and Blood-Related Issues:

  • Enlarged spleen (splenomegaly)

  • Increased risk of blood clots (thrombosis)

  • Bruising or bleeding

  • Thickened blood, which can impair circulation and oxygen delivery

When to Be Concerned

If a blood test reveals elevated hemoglobin or RBC levels — especially if accompanied by the symptoms above — further medical evaluation is essential. PV and other causes of erythrocytosis may be detected through:

  • Complete blood count (CBC)

  • Blood oxygen levels

  • JAK2 genetic testing

  • Bone marrow biopsy (in certain cases)

Treatment and Management

Treatment depends on the underlying cause:

  • For dehydration or high-altitude exposure: Rehydration and acclimatization are usually sufficient.

  • For secondary causes (e.g., smoking or chronic lung disease): Managing the primary condition often resolves the elevated RBC count.

  • For PV:

    • Therapeutic phlebotomy (regular blood removal)

    • Medications to suppress bone marrow activity (e.g., hydroxyurea)

    • Aspirin to reduce the risk of clotting

    • JAK inhibitors in advanced cases

Final Thoughts

Elevated red blood cells and hemoglobin levels should not be ignored, especially if persistent or accompanied by other symptoms. While the cause may be benign, such as dehydration or high altitude, conditions like Polycythemia Vera require medical diagnosis and long-term management to prevent complications like thrombosis or stroke.

This is not a medical advice. 

If you are experiencing symptoms or have abnormal lab results, consult a healthcare provider to determine the underlying cause and begin appropriate treatment. Early detection and management can make a significant difference in health outcomes.

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right. Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9  

Example (German Lab results):  

 

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