A high red blood cell count, medically known as polycythemia or erythrocytosis, causes the blood to become thicker and flow more slowly. This increased viscosity affects circulation throughout the body, leading to a variety of symptoms that can range from mild and vague to severe and life-threatening.
Common symptoms of high red blood cell count
For many, the symptoms of polycythemia can develop slowly over time, making them easy to dismiss as part of normal aging or stress. However, recognizing these common indicators is the first step toward a diagnosis.
General and neurological symptoms
- Fatigue and Weakness: Despite getting enough rest, a persistent feeling of low energy is one of the most frequently reported symptoms.
- Headaches: Frequent, dull headaches are common due to the increased blood thickness affecting circulation to the brain.
- Dizziness and Vertigo: A feeling of lightheadedness or unsteadiness can occur.
- Blurred or Double Vision: Visual disturbances can be a sign of poor blood flow to the eyes.
- Tinnitus: This is a ringing or buzzing sound in the ears, which can also be related to changes in blood flow.
- Numbness, Tingling, or Burning: A sensation of pins and needles, particularly in the hands and feet, is a common neurological symptom.
Skin and circulatory symptoms
- Itchy Skin (Pruritus): A hallmark symptom is itching, often intensified by a warm bath or shower.
- Flushed or Reddened Skin: A red or ruddy complexion, especially on the face, hands, and feet, is often visible.
- Bruising and Bleeding: While it may seem paradoxical, an overabundance of blood cells can cause platelet dysfunction, leading to easier bruising or nosebleeds.
- Gout: High red blood cell turnover can lead to an excess of uric acid in the body, causing painful joint inflammation, especially in the big toe.
The underlying causes of polycythemia
Polycythemia can be classified into two main types: primary and secondary.
Primary polycythemia (polycythemia vera)
This is a type of blood cancer where a mutation in the bone marrow causes the overproduction of red blood cells. In most cases, a gene mutation called JAK2 is responsible. It is a chronic condition that develops slowly.
Secondary polycythemia
This form is caused by an underlying condition or environmental factor that triggers the body to produce more red blood cells. Causes include:
- Low Oxygen Levels (Hypoxia): The body compensates for low oxygen by making more red blood cells to carry oxygen more efficiently. This can be caused by:
- Chronic Obstructive Pulmonary Disease (COPD)
- Heart failure
- Sleep apnea
- Living at high altitudes
- Kidney Disease: Rarely, some kidney cancers or other conditions can cause the kidneys to produce too much erythropoietin (EPO), the hormone that stimulates red blood cell production.
- Lifestyle Factors: Smoking and dehydration can also lead to higher blood cell counts. Dehydration increases the concentration of red blood cells in the blood, though not the total number.
Serious complications of untreated polycythemia
Left untreated, the thickened, sluggish blood can cause severe and sometimes life-threatening complications.
- Blood Clots (Thrombosis): The most serious risk, as clots can travel to the brain (stroke), heart (heart attack), or lungs (pulmonary embolism).
- Enlarged Spleen (Splenomegaly): The spleen works harder to filter the excess blood cells, causing it to become enlarged and potentially painful.
- Stomach Ulcers: Increased histamine release associated with polycythemia can lead to excess stomach acid and ulcers.
- Progression to other blood cancers: In rare cases, primary polycythemia can evolve into more aggressive blood disorders, including acute myeloid leukemia.
Comparison of primary vs. secondary polycythemia
| Feature | Primary Polycythemia (Polycythemia Vera) | Secondary Polycythemia |
|---|---|---|
| Cause | Genetic mutation in bone marrow (e.g., JAK2) | Underlying condition or external factor |
| Associated Conditions | Cancerous, but progresses slowly | Heart disease, lung disease, high altitude, sleep apnea |
| Other Blood Cells | Often affects all blood cells (platelets, white blood cells) | Usually only affects red blood cell count |
| Symptoms | Itching, enlarged spleen common | Symptoms often relate to the underlying cause |
| Treatment Focus | Managing blood cell counts and preventing clots | Treating the root cause (e.g., CPAP for sleep apnea) |
Diagnosis and treatment
Diagnosis typically begins with a complete blood count (CBC) test, which measures the number of red blood cells. Further tests, such as genetic testing for the JAK2 mutation, are then performed to determine the type and cause.
Treatment options
Treatment is determined by the underlying cause and severity of the condition.
- Phlebotomy: The most common treatment involves regularly removing blood from a vein to reduce the number of red blood cells, similar to donating blood. This provides immediate relief from symptoms.
- Medications: Low-dose aspirin may be prescribed to reduce the risk of blood clots. Other medications, like hydroxyurea, can be used to suppress bone marrow production of blood cells in more severe cases.
- Addressing the Underlying Cause: For secondary polycythemia, treating the root cause is key. This could involve using a CPAP machine for sleep apnea or managing chronic lung conditions.
- Lifestyle Changes: Staying hydrated, quitting smoking, and avoiding high altitudes are important for managing symptoms.
When to see a doctor
If you experience persistent symptoms associated with polycythemia, it's crucial to see a healthcare provider. While many symptoms can be caused by other conditions, early diagnosis and treatment are vital to prevent serious complications like blood clots.
For more detailed information on polycythemia and its management, consult the National Institutes of Health resources.
Conclusion
Understanding how do you feel if you have too many red blood cells is essential for early diagnosis and prevention of serious health issues. From fatigue and headaches to more specific signs like itchy skin after bathing, paying attention to your body's signals can make a significant difference. If you recognize these symptoms, consult a healthcare professional to determine the underlying cause and the best course of action. Effective management can help control symptoms and minimize the risk of complications, allowing you to maintain a better quality of life.
