Question: I recently did whole blood, and my doctor said they were all in the normal range, but my red blood cells said they were much higher than the last time I did them a few years ago I did. I am a woman in her late 40s. He suggested that I go back to redo them in 6 months. What does an increase in red blood cells mean? How can I lower red blood cells?

Dr. Grant’s Answer: I need a little more detail to correctly interpret your question. Does your “red blood cell” have a high number of hemoglobin (red blood cells that carry oxygen)? Or is the hemoglobin within the normal range, even though the number of RBCs (red blood cells) is simply high? Second, what are the other measurements of red blood cells (MCV, HCT, MCH, MCHC) and the iron storage such as ferritin, serum iron and transferrin saturation? Third, do you have a regular menstrual period or do you have an IUD (intrauterine device) for contraceptive reasons? Women without regular menstruation may see higher iron stores than previously noted on regular blood tests. Are you taking iron supplements or multivitamins with low doses of iron? How much lean meat do you eat each week? Keep in mind that chicken and fish contain about 70% iron compared to lean meat. Finally, does your family have a history of iron overload (hemochromatosis)?

Ireland has the highest incidence of a genetic condition called hereditary hemochromatosis (HH) in the world. Iron overload due to HH is when the body absorbs excess iron from food and deposits it in other tissues. Most commonly, iron deposits in the pancreas can cause liver tension (even liver failure if not caught in a timely manner) and diabetes. Historically, this type of diabetes was known as bronze diabetes because it causes the skin to tan or appear bronze. However, deposits of iron in other tissues such as the heart, bones, and joints can lead to heart failure, joint pain, malaise, depression, and decreased libido. These signs and symptoms often become apparent after the age of 40.

Fortunately, if two measurements of iron stores in the blood, namely ferritin and transferrin saturation, are increased and the blood sample is sent for genetic testing, the diagnosis is relatively simple. Treatment is simple phlebotomy (1 pint of blood) several times a year. Once the iron store is back in normal range, blood can be donated to the Irish Transfusion Commission. In addition, with timely diagnosis and good treatment compliance, mortality in HH patients is no different than in the general population.

Some care should always be taken regarding the interpretation of regular blood tests in healthy people with no signs or symptoms. Things often return to normal, so the golden rule is to always repeat blood tests. You generally don’t need to worry unless the high “red blood cells” are persistently high after repeated blood tests or worsening. At a practical level, consider reducing (or giving up) lean meat (if applicable), reducing chicken / fish content and being considered a health-promoting behaviour, so 2 liters of water per day Aim to drink.

Dr. Jennifer Grant is a general practitioner of Beacon Health Check

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