Red blood cells, commonly known as “red blood cells”, are the most numerous type of cell in the blood, and they contain hemoglobin, which gives the blood its red color. Therefore, the two changes of red blood cells and hemoglobin in routine blood tests are generally the same. Recently, many patients have received routine blood tests and found that the hemoglobin and red blood cells are elevated in the routine blood tests, asking if the problem is serious. What are the relevant tests that should be done? The following is a brief analysis of the causes of elevated red blood cells and hemoglobin, related laboratory tests and treatment.
The causes of elevated red blood cells and hemoglobin include two main areas.
Primary erythrocyte (hemoglobin) increase and secondary erythrocyte (hemoglobin) increase.
I. Primary erythrocytosis (true erythrocytosis)
1, Overview.
Primary erythrocytosis is a myeloproliferative disease due to clonal proliferation of abnormal pluripotent stem cells, mainly seen in middle-aged and elderly men.
2, Clinical manifestations.
The onset of the disease is relatively insidious, common symptoms are weakness, dizziness, vertigo; can also be no clinical symptoms, only in the physical examination of blood tests found; skin mucous membrane appearance such as “drunken appearance” (lips, nose, earlobes, palms and conjunctiva and other parts of the skin mucous membrane is dark red); a few patients with “cerebral thrombosis, myocardial infarction, venous embolism, and other parts of the blood. A small number of patients visit the clinic with symptoms such as “cerebral thrombosis, myocardial infarction, venous embolism, cerebral hemorrhage”; some patients may develop hyperuricemia.
3. Laboratory tests.
(1) blood routine: red blood cells are generally in the range of 6-10×1012/L, hemoglobin in the range of 180-240g/L, some patients may have increased white blood cells and platelets.
(2) Bone marrow morphology: the bone marrow proliferation is abnormally active, dominated by the proliferation of red lineage cells at different stages of development, often accompanied by the simultaneous proliferation of granulocytes and megakaryocyte lineage.
(3) Chromosomal examination: trisomy 8, trisomy 9, 2q-, 5q-, 11q- and 13q deletions are the most common.
(4) Blood oxygen saturation: normal.
(5) Erythropoiesis (EPO) measurement: decreased.
4. Treatment.
(1) venous bloodletting: this method is a symptomatic treatment method, the advantage is that it can make the patient’s blood volume will be normal in a relatively short period of time, reduce the symptoms, reduce the chance of bleeding and thrombosis, every 2-3 d bloodletting 200-400 ml, until the red blood cell count is below 6.0 × 1012 / L, red blood cell pressure product is below 50%, bloodletting once can maintain the efficacy for more than 1 month. However, attention should be paid to the possibility of rebound increase of red blood cells and platelets after bloodletting, and repeated bloodletting has the tendency to aggravate iron deficiency.
(2) Erythrocyte monopexy: this method is also a symptomatic treatment method, is the use of blood cell separator to directly remove red blood cell components; Erythrocyte monopexy often provokes the bone marrow reactive proliferation, so the postoperative application of chemotherapy drugs to consolidate treatment.
(3) chemotherapy: hydroxyurea, high trichostatin, leucovorin, cyclophosphamide, nitrogen mustard phenylbutyrate, γ-interferon, etc.
5.Prognosis.
The prognosis of this disease is poor, most die from venous embolism, hemorrhage, or develop into myelofibrosis and acute leukemia.
Second, secondary erythrocytosis
1, Overview.
Secondary erythrocytosis is due to different causes, caused by the secondary increase in red blood cells.
2, Etiology.
(1) neonatal hematocrit: normal full-term neonatal erythrocytes are generally 5.7-6.4×1012/L and hemoglobin is 180-190g/L. This is due to the fetus being in a state of physiological hypoxia in the mother’s body secondary to erythrocyte increase, this condition is physiological erythrocyte increase and does not require treatment.
(2) Plateau erythropoiesis: the low air pressure in the plateau area, people in the area are in a long-term hypoxic state, so secondary to the production of erythropoiesis, this situation also belongs to the physiological erythropoiesis, no need to deal with.
(3) Erythrocyte increase due to chronic lung diseases: such as “emphysema, long-term bronchial asthma, pulmonary heart disease, pulmonary embolism”, etc.
(4) Erythrocytosis due to cardiovascular diseases: such as congenital heart disease (e.g. congenital tetralogy of Fallot), etc.
(5) Erythrocytosis due to abnormal hemoglobinopathies.
(6) Kidney diseases: such as “kidney cancer, polycystic kidney, hydronephrosis, benign adenoma of the kidney”, etc.
(7) Adrenal diseases: such as “pheochromocytoma, Cushing’s syndrome, Mr. adrenal hyperplasia, adrenal adenoma combined with primary aldosteronism”, etc.
(8) Liver diseases: such as “hepatocellular carcinoma, hepatic hemangioma, metastatic hepatocellular carcinoma, hepatocellular sarcoma”, etc.
(9) Drug-induced erythrocytosis: Mostly seen in patients on “testosterone or similar substances, growth hormone”.
3.Treatment.
(1) The principle is to treat the primary disease, with the primary disease control or cure, secondary erythrocytosis will improve or disappear.
(2) Remove the factors that can cause or aggravate erythrocytosis.
(3) If necessary, intravenous bloodletting treatment can be used to relieve symptoms.
4. Prognosis.
It mainly depends on the prognosis of the primary disease.