From the Guidelines
If you have high erythrocytes, it is crucial to consult with a healthcare provider for proper evaluation and management to reduce the risk of blood clots, stroke, and heart attack, as evidenced by the complex classification of polycythemia in a comprehensive review 1. High erythrocytes, also known as erythrocytosis or polycythemia, refers to an abnormally elevated red blood cell count in the blood. The diagnosis of polycythemia can be challenging, and a diagnostic algorithm should be followed to make a working diagnosis, including the determination of serum EPO and the examination of bone marrow histology 1.
Key Considerations
- The first step in the diagnostic evaluation of PV is to determine whether this diagnosis should be suspected, based on factors such as hemoglobin/hematocrit level, documented increase in the hemoglobin/hematocrit level, or presence of PV-related features like thrombocytosis, leukocytosis, or splenomegaly 1.
- Treatment depends on the underlying cause and may include therapeutic phlebotomy (blood removal), hydration, lifestyle modifications, or medication, with medications like hydroxyurea, ruxolitinib, or aspirin prescribed for primary polycythemia (polycythemia vera) 1.
- Secondary causes require addressing the underlying condition, such as stopping smoking, treating sleep apnea, or managing heart or lung disease, as these conditions can lead to hypoxia-driven polycythemia 1.
Management and Monitoring
- Regular monitoring of blood counts and staying well-hydrated are important aspects of management, as high erythrocytes can increase blood viscosity, raising the risk of blood clots, stroke, and heart attack 1.
- Symptoms of high erythrocytes include headaches, dizziness, fatigue, and itchy skin, which should be promptly evaluated by a healthcare provider to determine the underlying cause and appropriate treatment 1.
From the Research
High Erythrocytes
- High erythrocytes, also known as erythrocytosis, is a characteristic feature of polycythemia vera (PV) and essential thrombocythemia (ET) 2, 3, 4, 5, 6
- PV is defined by a JAK2 mutation, whose absence, combined with normal or increased serum erythropoietin level, makes the diagnosis unlikely 4, 5, 6
- The presence of JAK2 mutation is expected in PV, while approximately 90% of patients with ET express mutually exclusive JAK2, CALR, or MPL mutations 2, 3
Diagnosis and Risk Stratification
- Bone marrow morphology remains the cornerstone of diagnosis 2, 3, 4, 5
- Risk stratification in PV and ET is designed to estimate the likelihood of recurrent thrombosis 2, 3, 4, 5
- In PV, two risk categories are considered: high (age > 60 years or thrombosis history present) and low (absence of both risk factors) 2, 3, 5
- In ET, four risk categories are considered: very low (age ≤ 60 years, no thrombosis history, JAK2 wild-type), low (same as very low but JAK2 mutation present), intermediate (age > 60 years, no thrombosis history, JAK2 wild-type) and high (thrombosis history present or age > 60 years with JAK2 mutation) 2, 3, 5
Treatment and Management
- The main goal of therapy in both PV and ET is to prevent thrombohemorrhagic complications 2, 3, 4, 5
- All patients with PV require phlebotomy to keep hematocrit below 45% and once-daily or twice-daily aspirin (81 mg), in the absence of contraindications 2, 3, 5, 6
- Cytoreductive therapy is recommended for high-risk ET and PV, but it is not mandatory for intermediate-risk ET 2, 3, 5
- First-line drug of choice for cytoreductive therapy, in both ET and PV, is hydroxyurea and second-line drugs of choice are interferon-α and busulfan 2, 3, 5