It is common to see some patients in outpatient clinics either during physical examinations, either because of neurological symptoms or because of infarcts or bleeding to check the blood count and find elevated red blood cells, so what diseases are seen with high red blood cells?
Erythrocytes are commonly found in true erythrocytosis, secondary and relative erythrocytosis. First, let’s look at PV, which is a clonal disease of hematopoietic stem cells of unknown origin and belongs to the category of myeloproliferative diseases. It has an insidious onset.
Clinical manifestations.
(1) Neurological symptoms: headache, dizziness, swelling and numbness of the extremities are common
(2) polycythemia vera: conjunctival congestion, red face and purple lips are common.
(3) Bleeding: gum bleeding, rhinorrhea, gastrointestinal bleeding are common
(4) Splenomegaly
(5) Hypertension: mostly mild to moderate
(6) Thrombosis: common in cerebral thrombosis, followed by coronary artery of the heart, deep veins of the lower limbs, etc.
(7) Some patients also have symptoms such as itching of the skin.
Laboratory tests.
(1) red blood cells ≥ 6 × 1012 / L, hemoglobin ≥ 180g / L, hematocrit ≥ 50%.
(2) Active or apparently active proliferation in bone marrow examination, with predominantly red lineage proliferation.
(3) Positive for JAK2 gene.
The finding of erythrocyte hyperplasia must be differentiated from secondary and relative erythrocytosis. Secondary erythropoiesis is caused by elevated erythropoietin due to long-term chronic hypoxia, which stimulates the bone marrow to overreact. Relative erythropoiesis, also known as benign erythropoiesis, is due to a decrease in blood volume and is not a true erythropoiesis, and can return to normal with the removal of the trigger.
Treatment of true erythrocytosis.
It is to inhibit abnormal proliferation of bone marrow red lineage cells, reduce blood volume, reduce blood viscosity, eliminate various signs and symptoms caused by erythrocytosis, reduce thromboembolism and bleeding complications, improve quality of life and prolong survival.
Currently, the following are commonly used in clinical practice.
(1) bloodletting, 200-400ml each time
(2) Myelosuppressive drugs such as hydroxyurea
(3) Interferon
(4) Targeted therapy drugs for JAK2 gene
(5) Chinese herbal medicine treatment.
The disease mostly develops slowly, and the median survival is up to 10-15 years after various treatments. The leading cause of death is thromboembolic complications, so low-dose aspirin is recommended for long-term prophylaxis.