From the Guidelines
Elevated hemoglobin, also known as polycythemia, can be caused by several conditions, including dehydration, chronic hypoxia, smoking, genetic disorders like polycythemia vera, kidney disease, and certain medications or performance-enhancing drugs. The most common causes of elevated hemoglobin include:
- Dehydration, which concentrates the blood
- Chronic hypoxia from conditions like COPD, sleep apnea, or living at high altitude
- Smoking, which increases carbon monoxide in the blood
- Certain genetic disorders like polycythemia vera
- Kidney disease with increased erythropoietin production
- Certain medications or performance-enhancing drugs, such as testosterone-replacement therapy, which can stimulate erythropoiesis and increase hemoglobin levels by 15 to 20 percent, as seen in boys at puberty 1 Less commonly, it may result from certain tumors that produce erythropoietin or congenital heart defects. The body increases hemoglobin production in response to decreased oxygen levels to improve oxygen-carrying capacity. Treatment depends on identifying and addressing the underlying cause, which may include:
- Hydration
- Smoking cessation
- Oxygen therapy for hypoxic conditions
- Specific treatments for conditions like polycythemia vera, which might involve phlebotomy (blood removal) or medications like hydroxyurea, with therapeutic phlebotomy recommended for hemoglobin greater than 20 g per dL and hematocrit greater than 65%, associated with headache, increasing fatigue, or other symptoms of hyperviscosity in the absence of dehydration or anemia 1 It's essential to consult with a healthcare provider to determine the cause and appropriate management of elevated hemoglobin, as excessive phlebotomy can lead to iron depletion, decreased oxygen-carrying capacity, and stroke 1.
From the Research
Elevated Hemoglobin Causes
Elevated hemoglobin levels can lead to increased blood viscosity, which can cause a range of health problems. Some of the potential causes of elevated hemoglobin include:
- Polycythemia vera, a type of blood disorder that causes the body to produce too many red blood cells 2
- Dehydration, which can cause a concentration of red blood cells in the blood 3
- High-altitude living, which can cause the body to produce more red blood cells to compensate for the lower oxygen levels 3
- Smoking, which can damage the lungs and reduce oxygen levels in the blood, leading to an increase in red blood cell production 3
Health Risks Associated with Elevated Hemoglobin
Elevated hemoglobin levels can increase the risk of:
- Thrombosis, or blood clots, which can lead to heart attacks, strokes, and other cardiovascular problems 4, 2, 5
- Hyperviscosity syndrome, a condition characterized by increased blood viscosity and reduced blood flow to the organs 6
- Cardiovascular disease, which can lead to heart attacks, strokes, and other cardiovascular problems 4, 2
- Increased risk of infection, as increased blood viscosity can reduce tissue perfusion and increase the risk of infection 3
Treatment Options
Treatment options for elevated hemoglobin levels may include:
- Phlebotomy, or blood letting, to reduce the number of red blood cells in the blood 4, 2, 5
- Hydroxyurea, a medication that can help reduce the production of red blood cells 4, 2, 5
- Aspirin, which can help reduce the risk of blood clots 2
- Lifestyle changes, such as quitting smoking and staying hydrated, to help reduce the risk of elevated hemoglobin levels 3