Too Many Red Blood Cells – What Conditions Can It Lead To?

Red blood cells are also called Erythrocytes. We know for sure that red blood cells, white blood cells and platelets are important components of blood circulation.

Red blood cells are formed from erythroblasts produced in the bone marrow. Formation of red blood cells is called Erythropoiesis. Formation of red blood cells is influenced by a variety of nutritional and environmental factors. Erythropoietin secreted by the adrenal glands is essential for the production of red blood cells.

Red blood cells contain hemoglobin which is essential for imparting red color and also for transport of oxygen to body tissues.

Normal Range for Red Blood Cells

In males: 4.5 – 6 million/cmm of blood
In females: 4 – 5 million/cmm of blood

Hematocrit is another parameter to assess the percentage of red blood cells present in a given sample of blood.
A red blood cell count more than or less than the above mentioned range is considered abnormal and needs immediate attention and treatment.

What Causes too Many red Blood Cells?

High level of red blood cells is called Polycythemia. Polycythemia is a translation of a Greek word meaning “too many cells in the blood”. Polycythemia is a high hematocrit value in spite of a normal blood volume. Hematocrit values above 55% for females and 60% for men positively indicate polycythemia.

Too Many Red Blood Cells can Occur Because of Two Reasons

1. Uncontrolled production of red blood cells by the bone marrow.
2. Uncontrolled increase in erythropoietin secreted by the adrenal glands.

These causes for polycythemia can further be classified as absolute and relative.

Absolute or True Polycythemia (increase in hematocrit withan increase in blood volume)

Primary absolute polycythemia is called polycythemia vera. Other causes below are secondary causes of too many red blood cells.

1. Hereditary or Congenital Polycythemia
2. Hypoxemia due to
   ● Chronic Lung Disease
   ● Right To Left Cardiac Shunts
   ● Sleep Apnea
   ● High Altitude
   ● Smoking
   ● Carbon Monoxide Poisoning
3. Increased Automatic Erythropoietin Production
   ● Polycystic Kidney Disease
   ● Liver Cancer
   ● Parathyroid Cancer
   ● Pheochromocytoma
   ● Renal Cancer
   ● Cerebral Hemangioblastoma
   ● Uterine Cancer
4. External Administration of Excessive Erythropoietin
5. Uncertain Causes Like Post Renal Transplant and Anabolic Steroids

Relative Polycythemia (Normal Hematocrit)

1. Diuretic Medications
2. Dehydration
3. Smoking
4. Gaisbock Syndrome (polycythemia in obese men)
5. Dengue Fever

Mechanism of congenital or hereditary polycythemia is due to a genetic defect. In smokers, increase in carbon monoxide in circulating blood converts oxygen in hemoglobin to carboxy-hemoglobin (COHb). COHb has about 200 times higher affinity towards oxygen.

In tumors and renal and liver diseases, the cause for polycythemia is increased erythropoietin (Epo) production.
The cause of too many red blood cells post renal transplant is not clear. Yet, it is observed that in about 5-10% of patients, polycythemia develops within 8-24 months.

Having too many red blood cells is a relatively rare disorder. It is even rarer to find this among pregnant women. Yet, it is responsible for about 30% of abortions. A high level of estrogen is a possible protective agent which prevents the occurrence of polycythemia in pregnant women and women of child-bearing age group.

Too Many Red Blood Cells can Lead to What Condition?

• It generally affects middle-aged to old individuals.
• Engorged blood vessels due to excess of red blood cells give a red and flushed appearance to the skin.
• Itching of skin due to too many red blood cells.
• Headache due to congestion of blood vessels.
• Weakness, lethargy, joint pains and weight loss are common findings.
• Too many red blood cells can cause high blood pressure.
• Due to excess red blood cells, a rare occurrence of bleeding especially in the eye (retina) or nose may be seen.
• Bleeding may also occur beneath the skin which may appear to resemble bruise marks.
• Majority of patients are brought to the OPD setting only when they observe neurological changes like seizures, blindness or blurred vision, ringing sounds inside the ear, imbalance while walking and behavioral changes.
• An enlarged spleen is suggestive of polycythemia vera. This feature is seen in about 30-40% of patients.
• Non specific chest pain or acute severe abdominal pain may be present. This requires immediate attention. Blockage of major blood vessels could be the cause for pain.

A detailed history taking is essential to reach a definitive diagnosis and to differentiate between absolute and relative polycythemia. A complete physical examination with a complete blood count analysis will help to differentiate between the two varieties of polycythemia. Serum erythropoietin levels, JAK2 mutation gene and a bone marrow analysis is recommended as diagnostic tests for polycthythemia vera.

How to Reduce Red Blood Cells Naturally?

Treating the cause is of utmost importance. A proper professional help needs to be sought before resorting to any kind of other natural, home remedies or alternative therapies.

While treating polycythemia, the prime aim is to prevent blockage of some major blood vessel in the body, to avoid its recurrence, to delay or prevent the possibility of this condition to turn into leukemia and to reduce the signs and symptoms associated with this disease condition.

Despite the on-going treatment, if any alarming symptoms like bleeding, severe pain in any part of the body and neurological symptoms show up, it becomes mandatory to report to the out-patient department.

Once the Cause is Identified, Further Steps Should be Taken to Control Factors which Maintain The Clinical Condition. This Includes

1. Curb smoking and alcohol intake. Smoking increases the risk of thrombosis by two-folds in patients having too many red blood cells.
2. Congenital heart diseases should be treated surgically if possible.
3. Tumors causing erythropoietin production should be removed surgically.
4. Diuretics and other drugs should be withdrawn.
5. Hydration should be maintained if dehydration is a cause for too many red blood cells.
6. Moderate amount of exercise boosts blood circulation, reducing the risk of developing blood clots within blood vessels.
7. Having 2-3 cloves of garlic on an empty stomach in morning is known to prevent the risk of thrombosis or strokes.
8. Low sodium diet to manage blood pressure.
9. Low iron diet will reduce maturation of red blood cells and their release into circulation.
10. Aloe vera plant fresh extract can be had along with a glass of water everyday. Aloe vera has amazing health benefits which are also helpful in managing symptoms of polycythemia.

In conventional treatment, phlebotomy, cyto-reductive therapy drugs and a low dose of aspirin is used to manage too many red blood cells and also to prevent further complications. In pregnancy, a low dose of aspirin during gestation and a low-molecular weight heparin after delivery are helpful in managing and preventing complications of having too many red blood cells.