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Is there any necessity to drain blood with a haemoglobin count of 182?

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Practicing since : 2004
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Hi, I had a FBC for a lump found in my neck and the results came back today. As a separate issue to the lump, my doctor flagged up my haemoglobin level as a concern. The count is 182. The only other result my doctor has for comparison was a May 2012 test when my level was 174. He said he could not explain the high level and wanted to do a follow-up test in three months to monitor the level. He then said that if the level continued to rise it may be necessary to 'drain blood'. My questions are; i. Is there any need to be concerned over a 182 count (and what are those concerns)? ii. What are the normal control measures? iii. How common is it and at what level is it necessary to drain blood? And is this a one-time procedure or a regular process? Many Thanks, XXXXXXX
Posted Wed, 25 Dec 2013 in Blood Disorders
Answered by Dr. Indranil Ghosh 14 hours later
Brief Answer: Need to find out the exact cause Detailed Answer: Hi Thanks for your query. The hemoglobin level is a bit high in you. But the cutoff for males is usually 185, so it is borderline at this point (with a rising trend). There are many causes to raised hemoglobin, like smoking, high altitude, lung disorders, heart disorders, androgen use, etc. All these should be ruled out as the treatment in these conditions is directed to the underlying disease and not draining blood. If all these are excluded, then primary polycythemia is suspected and some tests are used to confirm it. For this condition, blood draining is used, that too above 200. Concerns are reduced blood flow to organs like brain due to thick blood and clot formation in vessels. Hence blood needs to be drained at appropriate intervals to keep hemoglobin below 150. In addition, sometimes other drugs to reduce blood cells, like hydroxyurea are used. However, in you, first we need to see whether the hemoglobin rises further or not, then exclude other causes and then only reach the diagnosis of primary polycythemia. Take it step-by step. Hope I have answered your query. I will be available to answer further followup queries, if any.
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Follow-up: Is there any necessity to drain blood with a haemoglobin count of 182? 4 hours later
Thank you Dr. XXXXXXX this answers my questions. I have a few follow up questions; Regarding the blood test itself; I have read that both dehydration and time of day can give falsely high readings (highest at 8am - lowest at 8pm). My test was taken at 9am on Monday morning. I had been at a wedding over the Saturday and Sunday and had been drinking heavily hence I expect I would have been dehydrated on the monday morning when the blood was taken. Do you think that this could have had an impact on the reading and if so to what extent? And could the time of day even explain the fluctuation between the 2012 test at 174 and this week's test at 182 (given that the 2012 was taken late in the afternoon)? Secondly, if I was to have a level which always fluctuated between (say 170 and 180) - could this be normal? And would it be healthy? And would I be able to live without risk of it getting higher or would i have to have it checked regularly? Thirdly, I intend to quit smoking as of today. Is there anything else i can be doing to be pro-active in bringing my hemoglobin level down? Is it safe to exercise with high levels and will this help? Finally, how rare is primary polycythemia (generally and for my age group) and is it possible to give an idea of how many cases like mine as it currently stands would ultimately result in the condition? Many thanks for your assistance so far, XXXXXXX
Answered by Dr. Indranil Ghosh 3 hours later
Brief Answer: please refer below Detailed Answer: My answers 1. Dehydration can certainly affect hemoglobin concentration. As you were drinking heavily, this could have raised it by around 5-10%. I don't think time of the day matters much. 2. As I said, in you, a level above 185 is significant and if yours is stable at below this level, then nothing to worry. It will need regular checking to confirm that it is indeed stable. 3. There is nothing else that you can do in terms of lifestyle changes. Exercise is good but too much can actually get hemoglobin to rise 4. Primary polycythemia is quite rare in the general population (occurring in 0.6-1.6 persons per million population) and more so in your age group. May be 2-3 per 1000 of such borderline hemoglobin will eventually turn out as primary polycythemia at your age. Hope this helps. Regards
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