High HGB, HCT, RBC

[macwriter77]

My husband who is 61 had a mild heart attack in 2007. He also has controlled asthma -- hardly ever uses inhalers or other meds for it. Has diabetes 2 controlled by metformin and glipizide. He's on Plavix, Toprol, ramipril and lipitor for heart maintenance. He also takes niacin. For the last three years, ever since his heart attack, he has had blood work done every three months. It always comes back the same. His HGB ranges from 18 -- 19, his HCT from 53% to 58%, his RBC 6.3 to 6.5. It is not getting worse, it's not getting better, it just bounces around in this range. He really never had bloodwork done before that, so it could have been high longer than that. My husband has no symptoms of anything being wrong with him. No pains or aches -- no shortness of breath. He's a bundle of energy, says he's never felt better since they put one drug-eluding stent in his heart after the heart attack. His cardiologist has done an echo cardiogram and says it looks great -- can hardly tell where he had the heart attack. At the last cardiologist appointment, however, he said although my husband's "numbers" are great, he wants to make them "perfect" and to see a hematologist for the high HGB, HCT, and RBC -- his liver and kidney functions are completely normal, by the way, and always have been. We've been to see a hematologist who said that she didn't think my husband had primary polycythemia because he had no symptoms, but it could have secondary polycythemia. Now, I'm scared to death about the prospect that my husband has kidney cancer. She's running some blood tests and plans to run more and maybe do a CTscan. Is it possible that my husband could have had kidney or liver cancer for at least three years and have no symptoms and not become ill by now or even have impaired liver or kidney function. My husband smoked years ago (a pipe) but hasn't smoked since he developed asthma at age 39. We don't live at high altitudes and he doesn't use steroids or take diuretics. He is about 25 pounds overweight, but just started attending weight watchers and taking that off now. Sorry for being long-winded, but I wanted to include all the info.

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
The simplest cause for high RBC, HGB and HCT could be low oxygen in body. Get a pulse oxymeter and a PFT (pulmonary function test) done. With a history of asthma this is the most likely cause and tissue hypoxia, low Oxygen in blood and lungs should be looked into. Dehydration is another common cause. Hence increase your husband’s fluid intake and see. People with asthma need more fluids than normal people (however do not go overboard, see he drinks 8-10 glasses of fluids in a day). Other causes such as polycythemia vera, kidney problems and the possibility of a heart disease should also be looked into.
Hope this helps. Do discuss this with your doctor and get your husband examined. Please let me know if there is any thing else and do keep me posted. Take care!

[LivingInHope]

Have you gotten any result back from those tests the hematologist was running?

I have a Manual of Laboratory Diagnostic Tests, second edition by Frances Fischbach (very old) that indicates an interfering factor that can cause high RBCs, hemoglobin and hematocrit can be living at a higher altitude, looks like having to do with decreased oxygen content in the air- you say you don't live at a high altitude, but have you checked the oxygen level in your house?  It also looks like all of these levels can be affected by level of hydration- could your husband be dehydrated when he's getting his blood drawn?

Under RBC, it lists that secondary polycythemia is "seen in erythropoietin-secreting tumors, in renal disorders such as hypernephroma and renal cysts, and in cancer of the liver".  The fact you say liver and kidney function tests are completely normal I think would be encouraging signs that whatever is causing the high numbers is not affecting the numbers for those organs.