From the Guidelines
Your hemoglobin level of 189 g/L is only slightly elevated and does not meet the criteria for therapeutic phlebotomy, which is typically considered for hemoglobin levels greater than 20 g/dL (200 g/L) and hematocrit greater than 65% with associated symptoms of hyperviscosity, as stated in the acc/aha 2008 guidelines 1.
Key Considerations
- The elevation in hemoglobin may be caused by various factors including dehydration, living at high altitude, smoking, certain lung diseases, heart conditions, or polycythemia vera (a bone marrow disorder).
- It is essential to consult with a healthcare provider for a thorough evaluation to determine the underlying cause of the elevated hemoglobin level.
- Additional tests such as a complete blood count, arterial oxygen levels, and possibly genetic testing or bone marrow examination may be recommended to identify the cause.
- Treatment will depend on the underlying cause but may include hydration, smoking cessation if applicable, or specific treatments for any identified underlying condition.
- Elevated hemoglobin increases blood viscosity, which can raise the risk of blood clots, stroke, and heart problems, but given the current level, immediate intervention like phlebotomy is not indicated unless symptoms of hyperviscosity are present, as per the guidelines 1.
Management Approach
- While waiting for a healthcare appointment, it is crucial to stay well-hydrated to help manage the condition and avoid activities that could further increase hemoglobin levels, such as smoking or using supplemental oxygen if not prescribed.
- Monitoring and follow-up with a healthcare provider are necessary to adjust the management plan based on the diagnosis and response to treatment.
- The guidelines emphasize the importance of avoiding repeated routine phlebotomies due to the risk of iron depletion, decreased oxygen-carrying capacity, and stroke 1, highlighting the need for a cautious and evidence-based approach to managing elevated hemoglobin levels.
From the Research
Hemoglobin Levels and Polycythemia Vera
- The patient's hemoglobin level is 189 g/L, which is above the normal range of 135-175 g/L 2, 3, 4, 5, 6.
- Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by an increased red blood cell mass and increased risk of thrombosis, which can be associated with elevated hemoglobin levels 2, 3, 4, 5, 6.
Diagnosis and Risk Stratification
- The diagnosis of PV is based on the presence of a JAK2 mutation, elevated hemoglobin or hematocrit levels, and abnormal bone marrow biopsy results 2, 3, 4, 5, 6.
- Risk stratification is important in PV, with high-risk patients (aged >60 years or with a history of thrombosis) requiring more aggressive treatment 2, 3, 4, 5.
Treatment and Management
- The goal of treatment in PV is to prevent thrombotic events and reduce symptoms, with low-dose aspirin and phlebotomy to maintain a hematocrit level <45% being first-line treatments 2, 3, 4, 5, 6.
- Cytoreductive therapy, such as hydroxyurea or interferon, may be added in high-risk patients or those with persistent symptoms 2, 3, 4, 5, 6.
- Ruxolitinib, a Janus kinase inhibitor, may be used in patients who are intolerant of or resistant to hydroxyurea 2, 3, 4, 5, 6.