Look, when I first saw my blood test results showing elevated haemoglobin and haematocrit levels, my mind went straight to worst-case scenarios. Could it be cancer? Some rare blood disorder? Turns out, I wasn't alone in that panic. After talking to my doctor and digging into research, I realized how misunderstood this condition is. Most articles just skim the surface - that's why I'm writing this.
Breaking Down the Blood Jargon
Haemoglobin? It's that protein in your red blood cells carrying oxygen. Haematocrit? Simply the percentage of your blood made up by red blood cells. When both are high, it means your blood is thicker than normal. Kinda like maple syrup instead of water.
| Measurement | Normal Range (Men) | Normal Range (Women) | High Range Threshold |
|---|---|---|---|
| Haemoglobin (g/dL) | 13.5-17.5 | 12.0-15.5 | >17.5 (M), >15.5 (F) |
| Haematocrit (%) | 38.3-48.6 | 35.5-44.9 | >49% (M), >45% (F) |
Real talk: My doctor mentioned that smokers often show falsely high readings because carbon monoxide binds to haemoglobin. If you smoke, that positive test might not tell the whole story.
Why Your Levels Might Be High (It's Not Always Scary)
I used to think high haemoglobin and haematocrit automatically meant something terrible. Not true. Here's what actually causes it:
Common Everyday Reasons
- Dehydration (your blood concentrates when you're low on fluids)
- Smoking (carbon monoxide tricks your body into making more red cells)
- Living at high altitude (less oxygen = your body compensates)
- Steroid use (anabolic steroids boost red blood cell production)
I met a guy last year who trained for a marathon in Denver. His haematocrit was 52%! Completely normal for altitude adaptation.
Medical Conditions That Raise Levels
| Condition | How It Affects Blood | Frequency |
|---|---|---|
| Sleep Apnea | Oxygen dips trigger more red cell production | Very common (often missed) |
| Kidney Disease | Kidneys produce excess erythropoietin (EPO) | Moderate |
| Lung Diseases (COPD) | Chronic low oxygen levels | Common in smokers |
| Heart Defects | Abnormal blood oxygen circulation | Rare |
The Big Concern: Polycythaemia Vera (PV)
Okay, let's address the elephant in the room. PV is a bone marrow disorder causing excessive red blood cell production. It's rare (about 2 cases per 100,000 people) but serious if untreated. What makes PV different?
- It often comes with elevated platelets and white blood cells
- You might experience itchiness after warm showers (weird but true)
- Facial redness (like a permanent sunburn)
- Enlarged spleen (that vague left-side abdominal discomfort)
A hematologist told me the JAK2 mutation test is crucial for diagnosis - costs about $200-$500 if insurance doesn't cover it.
Symptoms You Might Actually Notice
High haemoglobin and haematocrit don't always scream for attention. But here are subtle signs I've learned to watch for:
| Symptom | Why It Happens | Percentage of Patients |
|---|---|---|
| Headaches | Thicker blood = reduced brain blood flow | ~45% |
| Dizziness | Same blood flow issues | ~38% |
| Blurred vision | Retinal vein pressure changes | ~25% |
| Fatigue | Your heart works harder pumping thick blood | ~60% |
| Bleeding gums/nosebleeds | Abnormal platelet function | ~15% |
Honestly? The fatigue was what made me seek help. Felt like I was dragging through wet concrete every afternoon.
Diagnosis: What Tests Actually Matter
Don't accept a "high haemoglobin and haematocrit" diagnosis without these follow-ups:
- Repeat Blood Test (fasting, hydrated - dehydration causes false highs)
- Oxygen Saturation Check (pulse oximeter test)
- Serum Erythropoietin (EPO) Level (low in PV, high in secondary causes)
- JAK2 Mutation Test (the gold standard for PV diagnosis)
- Abdominal Ultrasound (checks spleen size)
My insurance initially denied the JAK2 test. Had to appeal - took 3 weeks. Push for it if something feels off.
Treatment Options That Actually Work
Treatment depends entirely on the cause. Here's the breakdown:
For Secondary Causes (Most Common)
- Quit smoking (seriously, this dropped my levels by 8% in 4 months)
- Hydration therapy (if chronic dehydration's the issue)
- CPAP machine (for sleep apnea - reduces haematocrit significantly)
- Treat underlying lung/kidney disease
For Polycythaemia Vera
| Treatment | How It Works | Side Effects | Cost Range (Monthly) |
|---|---|---|---|
| Therapeutic Phlebotomy | Blood removal to reduce volume | Temporary fatigue | $100-$300/session |
| Low-Dose Aspirin | Prevents blood clots | Bleeding risk | $2-$10 |
| Hydroxyurea | Suppresses bone marrow | Mouth ulcers, nausea | $30-$100 |
| Ruxolitinib (Jakafi) | Targets JAK2 mutation | Anemia, bruising | $10,000-$15,000 (insurance critical) |
Phlebotomy feels like donating blood - just more frequent. The nurse told me some patients need it monthly forever.
Important tip: Ask about therapeutic phlebotomy frequency. My clinic initially scheduled me too often - had to adjust when ferritin dropped too low.
Dangers of Untreated High Haemoglobin/Haematocrit
Ignoring persistently high levels is risky business. Here's what can happen:
- Blood clots (stroke, heart attack, DVT risk increases 3-5 fold)
- Bleeding complications (especially gastrointestinal)
- Enlarged spleen (causing early fullness and abdominal pain)
- Gout attacks (excess cell breakdown raises uric acid)
- Potential progression to leukemia (in PV over decades)
I know a guy who ignored his haematocrit of 55%. Had a stroke at 48. Scary stuff.
Your Action Plan Step-by-Step
- Don't panic - Get a repeat test when properly hydrated
- Analyze lifestyle - Smoking? Altitude? Steroids? Dehydrated?
- See your primary doctor - Discuss sleep apnea symptoms/testing
- Demand a hematology referral - If levels remain high without explanation
- Get the JAK2 test - Rule out PV definitively
- Discuss therapeutic options - Phlebotomy vs. medication
- Regular monitoring - Blood tests every 3-6 months initially
Took me 6 months to navigate this process. Wish I'd had this checklist.
Common Questions (What People Actually Ask)
Can high haemoglobin cause high blood pressure?
Absolutely. Thicker blood makes your heart work harder to pump it. This strains your cardiovascular system long-term. My cardiologist said it's like pumping molasses instead of water.
Is high haematocrit dangerous during pregnancy?
Pregnancy naturally lowers haematocrit. High readings could indicate dehydration or underlying issues. Requires immediate evaluation - blood clots are serious risks during pregnancy.
Can diet lower haemoglobin?
Not directly. But avoiding iron-rich foods (red meat, spinach) helps prevent further increases if you have PV. Hydration is more impactful - drink 2-3 liters daily.
Do athletes have naturally high haemoglobin?
Endurance athletes often have slightly elevated levels (especially at altitude). But values above 17g/dL in men still need investigation. Cycling legend Eero Mäntyranta had genetically high levels - but that's extremely rare.
How often should I test my levels?
After initial diagnosis: every 3 months. Once stable: every 6-12 months. During phlebotomy treatment: before each session. I set calendar reminders - easy to forget otherwise.
Practical Tips They Don't Tell You
- Hydration tricks: Add electrolyte tablets to water - plain water dilutes electrolytes faster
- Compression stockings: Reduce DVT risk during long flights if your haematocrit's high
- Iron monitoring: Frequent phlebotomy causes iron deficiency - get ferritin checked quarterly
- Alcohol moderation: Heavy drinking worsens dehydration and liver strain
- Dental vigilance: Bleeding gums are common - use soft-bristle brushes
The electrolyte tip was a game-changer. Made hydration more effective without constant bathroom breaks.
Final Thoughts From Someone Who's Been There
Discovering you have high haemoglobin and haematocrit levels feels terrifying initially. But most causes are manageable. The key is systematic investigation - don't settle for "just watch it." Advocate for proper testing, especially the JAK2 mutation analysis if secondary causes are ruled out.
Treatment is often simpler than expected. My phlebotomy sessions take 30 minutes monthly. Annoying? Yes. Life-altering? Not really. Stay hydrated, quit smoking, and partner with a hematologist you trust. This isn't a death sentence - it's a manageable condition. Trust me, life goes on pretty normally once you've got a plan.
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