Understanding high hemoglobin: The physical sensations
High hemoglobin levels, medically known as erythrocytosis, occur when the body produces an excessive number of red blood cells. Hemoglobin is the protein within these cells that transports oxygen, and while more red blood cells may seem like a good thing, the resulting 'thicker' blood (hyperviscosity) can strain the circulatory system. This increased viscosity, along with potential underlying conditions, is what causes the symptoms associated with high hemoglobin. The way an individual feels can range from barely noticeable discomfort to severe, chronic symptoms that impact daily life.
Common symptoms of elevated hemoglobin
The symptoms often stem from the effects of thicker blood on the body's circulation and can manifest in various ways. These can sometimes be vague and easily mistaken for other conditions, which is why a proper diagnosis is crucial.
- Fatigue and Weakness: Despite the body carrying more oxygen, the heart must work harder to pump the thicker blood, leading to a feeling of exhaustion and generalized weakness.
- Headaches and Dizziness: The altered blood flow and increased pressure can cause frequent headaches and spells of dizziness. In severe cases, this can lead to vision problems.
- Itching (Pruritus): A very specific and common symptom, especially in those with polycythemia vera, is an intense, generalized itching that often worsens after a warm bath or shower.
- Numbness or Tingling: Thickened blood can impede proper circulation, causing a pins-and-needles sensation or numbness in the hands, feet, or limbs.
- Ruddy or Flushed Skin: A high red blood cell count can give the skin a reddish or purple tinge, particularly on the face, hands, and feet.
- Excessive Sweating: Increased metabolic activity can lead to unexplained and excessive sweating.
- Enlarged Spleen (Splenomegaly): The spleen works to filter old blood cells. With an excess, it can become enlarged, causing a feeling of fullness or pain in the upper left abdomen.
Causes of high hemoglobin
The root cause of high hemoglobin can be temporary and benign, or indicative of a more serious, chronic medical issue. Your doctor will need to investigate to determine the source of the problem.
Lifestyle and environmental factors
- Dehydration: When a person is dehydrated, their blood's plasma volume decreases, making the red blood cell percentage appear artificially high. Proper hydration often resolves this.
- High Altitude: Living at high altitudes means less oxygen is available. The body compensates by producing more red blood cells to maximize oxygen absorption.
- Smoking: Cigarette smoke contains carbon monoxide, which binds to hemoglobin and displaces oxygen. To compensate for the reduced oxygen-carrying capacity, the body produces more red blood cells.
- Performance-Enhancing Drugs: Misuse of drugs like erythropoietin (EPO) and anabolic steroids can stimulate the bone marrow to produce more red blood cells.
Medical conditions
- Polycythemia Vera (PV): A rare but serious bone marrow cancer where the body makes too many red blood cells, as well as white blood cells and platelets.
- Chronic Lung or Heart Disease: Conditions like Chronic Obstructive Pulmonary Disease (COPD) or congenital heart disease can cause chronically low blood oxygen levels. The body responds by making more red blood cells to try and compensate.
- Kidney Cancer or Tumors: In rare cases, some tumors can release erythropoietin, the hormone that stimulates red blood cell production.
Diagnosis and treatment
High hemoglobin is typically discovered during a routine Complete Blood Count (CBC) test. The next steps involve identifying the underlying cause and establishing a treatment plan, which may vary significantly.
Common treatments include:
- Therapeutic Phlebotomy: Similar to a blood donation, this procedure involves removing a unit of blood to reduce the number of red blood cells. It is a primary treatment for polycythemia vera.
- Medications: For conditions like polycythemia vera, medications such as aspirin may be used to reduce the risk of blood clots. Other drugs like Jakafi (ruxolitinib) can also help manage symptoms and blood cell counts.
- Addressing the Underlying Cause: For lifestyle-related causes, the solution is often straightforward. This may include staying hydrated, quitting smoking, or spending less time at high altitudes. For chronic diseases, managing the primary condition is key.
Comparing high vs. low hemoglobin symptoms
| Feature | High Hemoglobin (Polycythemia) | Low Hemoglobin (Anemia) |
|---|---|---|
| Symptom Profile | Headache, dizziness, fatigue, itching, flushed skin, blurry vision. | Fatigue, weakness, shortness of breath, pale skin, cold hands and feet. |
| Underlying Mechanism | Increased blood viscosity (thickness) due to excess red blood cells, straining circulation. | Inadequate oxygen transport due to a lack of red blood cells or hemoglobin. |
| Common Causes | Polycythemia vera, high altitude, smoking, lung or heart disease. | Iron deficiency, chronic disease, nutritional deficiencies, blood loss. |
| Key Risks | Blood clots, stroke, heart attack, enlarged spleen. | Heart problems, extreme fatigue, pregnancy complications. |
Potential complications and risks
The most significant risks associated with persistently high hemoglobin levels are related to the increased blood viscosity. The thicker blood is prone to forming clots, which can have life-threatening consequences.
- Thrombosis (Blood Clots): The risk of blood clots is substantially higher, potentially leading to deep vein thrombosis (DVT), pulmonary embolism (PE), heart attack, or stroke.
- Enlarged Spleen: The spleen works harder to filter the excess blood cells, causing it to swell and potentially rupture.
- Peptic Ulcers: An overproduction of red blood cells can sometimes lead to stomach ulcers due to increased acid production.
Conclusion
While some people with high hemoglobin may feel no symptoms, others experience a wide array of physical sensations, including fatigue, headaches, dizziness, and intense itching. These symptoms are often a result of increased blood viscosity, which can lead to serious complications such as blood clots. Identifying the underlying cause, whether it's a lifestyle factor like smoking or a medical condition like polycythemia vera, is essential for effective treatment. If you are experiencing symptoms or have received abnormal results on a blood test, consulting a healthcare provider is the most important step to ensure a correct diagnosis and manage the condition to prevent more severe health issues. For more information on polycythemia vera, a possible cause of high hemoglobin, visit the Mayo Clinic website.
