What is the significance of normal WBC, elevated RBC, high Hb, elevated Hct, normal MCV, MCH, and MCHC in a patient?

From the Guidelines

Your elevated red blood cell count, hemoglobin, and hematocrit levels suggest a condition called erythrocytosis or polycythemia, which may require further evaluation to determine the underlying cause. Given your blood test results, with a white blood cell count of 9.0 thousand/uL (normal), a red blood cell count of 5.46 million/uL (high), hemoglobin of 16.2 g/dL (high), and hematocrit of 48.5% (high), it is essential to consider the possibility of polycythemia vera (PV) or other conditions leading to erythrocytosis, as outlined in the study by 1. Some key points to consider based on your results and the guidelines provided by 1 include:

• Your hemoglobin and hematocrit levels are higher than the normal ranges, which could indicate erythrocytosis.
• The presence of elevated red blood cell parameters, such as your red blood cell count, hemoglobin, and hematocrit, may suggest a need for further evaluation to rule out conditions like polycythemia vera or secondary erythrocytosis due to other causes such as chronic lung disease, smoking, or high-altitude living.
• Normal red blood cell indices (MCV, MCH, MCHC) indicate that the size and hemoglobin content of your red blood cells are within normal limits.
• According to 1, the diagnostic evaluation of PV or erythrocytosis should consider whether the hemoglobin/hematocrit level is higher than the 95th percentile of the normal distribution or if there's a documented increase in these levels, along with the presence of any PV-related features.
• It is crucial to consult with your healthcare provider to discuss these results and determine the appropriate next steps, which may include additional tests such as serum EPO level or bone marrow examination, as suggested by 1, to identify the underlying cause of your elevated red blood cell parameters.

From the Research

Blood Test Results

• White blood cell count: 9.0 thousand/uL (normal range: 3.8-10.8 thousand/uL)
• Red blood cell count: 5.46 million/uL (high, normal range: 3.80-5.10 million/uL)
• Hemoglobin: 16.2 g/dL (high, normal range: 11.7-15.5 g/dL)
• Hematocrit: 48.5 % (high, normal range: 35.0-45.0 %)
• MCV: 88.8 fL (normal range: 80.0-100.0 fL)
• MCH: 29.7 pg (normal range: 27.0-33.0 pg)
• MCHC: 33.4

Possible Causes and Treatments

• The high red blood cell count, hemoglobin, and hematocrit levels may indicate erythrocytosis, which can be primary or secondary 2.
• Primary erythrocytosis, such as polycythemia vera (PV), is a myeloproliferative neoplasm that can increase the risk of thrombosis 3.
• Treatment strategies for PV include phlebotomy to lower hematocrit levels and reduce the risk of thrombosis 4.
• However, phlebotomy can exacerbate iron deficiency, which is common in patients with PV 4.
• Iron deficiency can produce symptoms such as fatigue, lethargy, and impaired concentration 4.
• New treatment strategies, such as hepcidin mimetics, are being developed to control hematocrit levels without requiring phlebotomy 4.

Diagnosis and Investigation

• The diagnosis of erythrocytosis involves measuring the erythropoietin level, which can indicate a primary or secondary cause 2.
• Further investigation may include mutational testing, bone marrow biopsy, and scans to identify the underlying cause of erythrocytosis 2.
• Iron deficiency can be diagnosed using biochemical and haematological laboratory findings, including ferritin measurement 5.
• The interpretation of these findings can be complex, and there is no standardization or consensus on the diagnostic cut-off for ferritin levels 5.