Early and Common Signs
Many people with an elevated red blood cell count, also known as polycythemia, may experience few or no symptoms in the early stages. The condition often progresses slowly, and initial signs can be subtle and easily overlooked. The thickening of the blood, or hyperviscosity, is the root cause of most symptoms, as it hinders proper blood flow and oxygen delivery throughout the body.
Some of the most common early symptoms include:
- Fatigue and Weakness: A persistent feeling of being tired or having low energy is frequently reported. Despite the increase in oxygen-carrying red cells, the sluggish blood flow means less oxygen reaches tissues efficiently.
- Headaches: Frequent or severe headaches, sometimes described as a feeling of fullness in the head, can occur due to slowed blood circulation in the brain.
- Dizziness or Lightheadedness: This sensation is also tied to the restricted blood flow, which can affect the brain's oxygen supply.
- Blurred Vision or Visual Disturbances: Impaired circulation to the eyes can cause vision problems like blurriness, double vision, or blind spots.
More Specific Symptoms and Complications
As the condition advances, more specific and noticeable symptoms often appear. These indicate the body's struggle to cope with the increased blood cell volume.
- Itchy Skin (Pruritus): A common and often intense symptom is an itching sensation, especially after a warm bath or shower. This is believed to be caused by the release of histamine from white blood cells, which can also be elevated.
- Numbness, Tingling, or Burning: A pins-and-needles sensation, medically known as paresthesia, can occur in the hands, feet, arms, or legs due to poor circulation.
- Redness of the Skin (Erythromelalgia): Some individuals notice a reddish or flushed appearance, particularly on the face, palms, and soles of the feet.
- Shortness of Breath: This can occur as the heart works harder to pump thick blood through the lungs, and may be especially noticeable when lying down.
- Enlarged Spleen (Splenomegaly): The spleen filters blood and removes old blood cells. The overload of excess red blood cells forces the spleen to work overtime, causing it to swell. This can result in a feeling of fullness or pain in the upper left abdomen.
- Bleeding Problems: Despite the high number of cells, some people can experience unusual bleeding, such as nosebleeds or bleeding gums.
- Gout: High red blood cell turnover can lead to elevated levels of uric acid, a waste product that causes gout, a painful form of arthritis.
Understanding the Causes of High Red Blood Cell Count
An elevated red blood cell count, or erythrocytosis, can arise from various factors. It is essential to determine the underlying cause to receive proper treatment.
- Polycythemia Vera (PV): This is a rare, slow-growing blood cancer that originates in the bone marrow. A genetic mutation, most often in the JAK2 gene, causes the bone marrow to produce too many red blood cells, and often other blood cells like platelets and white blood cells.
- Secondary Polycythemia: In this case, another medical condition or external factor stimulates the body to produce excess red blood cells. Common causes include:
- Low Oxygen Levels (Hypoxia): The body compensates for low oxygen by making more red blood cells. This can be caused by living at high altitudes, lung diseases (like COPD or pulmonary fibrosis), heart failure, or sleep apnea.
- Dehydration: When dehydrated, the plasma (liquid portion of blood) decreases, making the red blood cells more concentrated and artificially raising the count.
- Certain Medical Conditions: Kidney tumors or liver disease can sometimes trigger excess erythropoietin, a hormone that stimulates red blood cell production.
- Performance-Enhancing Drugs: The misuse of anabolic steroids or erythropoietin (EPO) can lead to a high red blood cell count.
Primary vs. Secondary Polycythemia: A Comparison
| Feature | Primary Polycythemia (e.g., Polycythemia Vera) | Secondary Polycythemia |
|---|---|---|
| Cause | Genetic mutation, typically JAK2, leading to overproduction in bone marrow. | An underlying condition or external factor causes the body to produce excess red blood cells. |
| Symptom Onset | Gradual and slow; often discovered during a routine blood test. | Can appear more suddenly or be associated with the underlying cause (e.g., symptoms of lung disease). |
| Treatment Focus | Managing the overproduction of blood cells via phlebotomy or medication. | Treating or correcting the underlying cause (e.g., improving oxygen levels). |
| Platelet Count | Often elevated alongside red blood cells. | Typically unaffected or normal. |
When to Seek Medical Attention
While some symptoms can be vague, persistent or worsening signs warrant a visit to a healthcare provider. A simple blood test can reveal a high red blood cell count, after which further testing can pinpoint the cause. Early diagnosis and management are crucial for preventing serious complications, especially life-threatening blood clots. You should seek immediate medical help if you experience signs of a heart attack, stroke, or deep vein thrombosis (DVT), such as chest pain, shortness of breath, sudden severe headache, or swelling and tenderness in a leg.
For more information on blood disorders and their management, a reliable resource is the National Heart, Lung, and Blood Institute.
Conclusion
Understanding how you feel when you have too many red blood cells is the first step toward seeking diagnosis and treatment. The symptoms, which stem from thickened blood, can be easily dismissed but should not be ignored. A high red blood cell count can indicate an underlying medical issue, and proper care is essential to manage symptoms and prevent dangerous complications like blood clots. With the right medical oversight and a treatment plan, many individuals can effectively manage their condition and lead a normal life.
