Note to those who suffer from high hematocrit

[maldorf]

I have been having persistent high hematocrit now ever since my heart attack despite only taking an hrt dose of 120 mg/wk. I have taken ever test that the hematologist can come up with, trying to find a reason for why mine is high. It has been around 53-55 now since the heart attack almost 2 years ago.

The last test we did was a bone marrow biopsy. They take a core sample of your bone and suck out your bone marrow which is sent off to lab for testing. Everything from the test came back normal, and so this means no cancer etc. My EPO levels are even a bit below normal. I tested negative for the JAK2 gene which means I dont have polycthemia vera.

It looks like my hematocrit/hemoglobin is high because of my weak heart. THe body increases your red blood cell count as a compensatory mechanism for dealing with your low cardiac output. Since with each beat my heart is only pushing out maybe 1/3 the blood it is supposed to, my blood now packs more oxygen per volume because my hemoglobin is above normal. It evens things out a bit. Because the higher hemoglobin is of benefit to me, the hematologist has decided to leave mine high since I will do very poor if he lowers it to normal. He has seen it make some patients bed ridden. I guess since im on coumadin and aspirin he isnt worried about my level. If the level does get up over 55 HCT or so he will have me do a phlebotomy.

The reason I am posting this is as another warning to people with high hematocrit. It could be that it is not entirely or not at all due to you using steroids. Your levels could be high because you have cardiomyopathy and dont even know it. I was once walking around at 35% ejection fraction and didnt know it. I thought that I was just overtrained or sick. You could have a 40% ejection fraction and not even feel a thing.

So if youre walking around feeling tired and get winded easier than you used to, think about this. If your resting heart rate, even when laying in bed, is high you need to consider this possibility. Chris and I both had resting heart rates around 100 BPM or so and had cardiomyopathy. Just wanted to make people aware of the fact that if you are using AAS and have a high hematocrit you cannot assume that it is due to the AAS use. Hematocrit can be high because of health reasons such as heart trouble. Chances are its just the AAS use, but you cannot rule out this other factor.

 

[Yohimbe33]

Thanks Maldorf-definitely going to get checked.

Also wanted to ask, with the aspirin, that it seems you're on fairly permanently, are you not at risk for an ulcer? What does the doc say?

 

[maldorf]

Thanks Maldorf-definitely going to get checked.

Also wanted to ask, with the aspirin, that it seems you're on fairly permanently, are you not at risk for an ulcer? What does the doc say?

No real risk there. You only need to take a baby aspirin, 81mg for the protection. No need for adult size aspirin, so if youre taking it now get off that and take just a baby. Taking an adult size has no benefit and could possibly cause some sides such as ulcer I suppose. The doc even told me that aspirin counteracts my ACE Inhibitor Lisinopril, so just another reason not to use more than a baby aspirin. Once again, more is not better.

 

[dragonfire101]

I have high hematocrit due to sleep apnea. So if you have sleep apnea and then use AAS, you may be leading yourself into some trouble for taxing the heart.

 

[Emery]

People with chronic obstructive pulmonary disease (COPD) also have high RBC/HCT due to the body craving more oxygen secondary to poor oxygenation of blood due to lung disease.

So asthma, emphysema, chronic bronchitis and such can lead to an increase in your numbers also!

A lot of times, smokers that have not yet been diagnosed with COPD, will have high RBC counts when lab is drawn.

 

[maldorf]

I have high hematocrit due to sleep apnea. So if you have sleep apnea and then use AAS, you may be leading yourself into some trouble for taxing the heart.

yeah, I did a sleep test for that too and I was fine. for me its my weak heart now. I think before my heart attack it was the cruising that got me.

 

[maldorf]

People with chronic obstructive pulmonary disease (COPD) also have high RBC/HCT due to the body craving more oxygen secondary to poor oxygenation of blood due to lung disease.

So asthma, emphysema, chronic bronchitis and such can lead to an increase in your numbers also!

A lot of times, smokers that have not yet been diagnosed with COPD, will have high RBC counts when lab is drawn.

Yes, yet another possibility! Anything that is going to deliver less O2 to the body than is normal can cause it. Of course one of the first tests to run is a blood gasses test to see where your oxygen level is at in the blood. I was normal on that too of course. They even ran a nuclear test on my blood to calculate my blood volume. That test took many hours to run.

 

[maldorf]

The main point here that has come across

As you can see, the human body is quite complicated. To assume that your high hematocrit is due solely to your AAS use is over simplification. Your condition could be due partly to the AAS raising it and it could also be partly due to one of the health conditions brought up in this thread. One thing for sure though, taking AAS for good length of time is going to elevate hct/hgb. Just dont assume its all due to that because you may just have another factor lurking in the darkness waiting to pounce on your ass when you least expect it. Just food for thought.

 

[aflo]

Ya maldorf, H/H can be elevated due to many factors. even the given time and hydration status at the time. AAS use will slightly raise levels... certain medications such as coumadin and asprin together can raise level because the sole fact that they are a prophylaxis. a good point a ER doc i work with always says is, much better to have a slightly elevated H/H than to have a low one.... GOOD point tho brotha!

 

[maldorf]

Ya maldorf, H/H can be elevated due to many factors. even the given time and hydration status at the time. AAS use will slightly raise levels... certain medications such as coumadin and asprin together can raise level because the sole fact that they are a prophylaxis. a good point a ER doc i work with always says is, much better to have a slightly elevated H/H than to have a low one.... GOOD point tho brotha!

Never head about coumadin and aspirin raising your hct/hgb. Not sure I understand how that works. Can you elaborate for me? Id really like to know about that because none of my doctors has even mentioned that. Im on both drugs of course.

 

[ironone1]

Good info, mine was high too.

 

[dragonfire101]

Never head about coumadin and aspirin raising your hct/hgb. Not sure I understand how that works. Can you elaborate for me? Id really like to know about that because none of my doctors has even mentioned that. Im on both drugs of course.

American Society of Hematology

Aspirin use safe and effective in patients with abnormal red cell counts (or with polycythemia)
(San Diego, Calif., December 7, 2003) � The use of low-dose aspirin significantly reduces the risk of thrombosis in patients with polycythemia vera, an abnormal increase in blood cells resulting from excess production by the bone marrow, according to a study presented today during the 45th Annual Meeting of the American Society of Hematology. Thrombosis is the formation or presence of a blood clot within a vessel that may cause a stroke or heart attack.

"These results indicate a high benefit/risk ratio of aspirin in a polycythemic population, suggesting that aspirin should be used in all patients with polycythemia vera having no contraindication to this treatment," said Raffaele Landolfi, M.D., of the Istituto di Medicina Interna e Geriatria, Universit� Cattolica, Rome, Italy, lead author of the study.

Aspirin treatment (100 mg per day) significantly reduced the risk of thrombosis in polycythemic patients who were undergoing standard cytoreductive treatments (therapies aimed at reducing the number of blood cells). Treatment with aspirin lowered the risk of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, pulmonary embolism, and venous thrombosis. The risk of minor thrombotic events was also significantly decreased.

Researchers reported no excess of major bleeding in patients on aspirin treatment. Major, total, and gastrointestinal bleedings were not significantly increased. Only the risk of nosebleeds, or epistaxix, was significantly increased.

Polycythemia vera is an acquired disorder of the bone marrow that causes the overproduction of all three blood cell lines � white and red blood cells and platelets. It is a relatively rare disease that occurs more frequently in men than women, usually within the age range of 40 to 80, although it may occur in younger subjects. Polycythemia vera develops slowly, and most patients do not experience any problems related to the disease after being diagnosed. However, the abnormal bone marrow cells may begin to grow uncontrollably in some patients leading to blood hyperviscosity.

Patients with polycythemia vera have an increased tendency to form blood clots that can result in strokes or heart attacks. Some patients may experience abnormal bleeding because their platelets are abnormal, but the major cause of death is thrombosis. The objective of treatment is to reduce high viscosity, or blood thickness, and to prevent uncontrollable bleeding and thrombosis. Removing some of the patient's blood periodically, called cytoreduction, is a common treatment.

The ECLAP Study (Efficacy and Safety of Low Dose Aspirin in Polycythemia Vera) was a multi-center, parallel, double-blind clinical trial that randomized 512 patients from 12 different countries to receive either 100 mg of aspirin daily or a placebo. By comparison, many over-the-counter aspirin tablets are often 325 mg. Sixty percent of the study population were males, with a mean age of 61 years, who had had the disease for an average of seven years. Patients were excluded from the trial if they needed antithrombotic therapy, had a contraindication to aspirin, or were unwilling to properly participate.

"This comprehensive study, showing mostly safe patient responses to aspirin, is an important therapeutic step for polycythemia vera patients who are predisposed to serious complications from clotting," said Ronald Hoffman, M.D., President of the American Society of Hematology. "Patients with abnormal levels of blood cells are at increased risk of developing life-threatening blood clots and bleeding, and, in some cases, may develop leukemia."



Pathol Biol (Paris). 2004 Jun;52(5):285-8.
A prospective analysis of thrombotic events in the European collaboration study on low-dose aspirin in polycythemia (ECLAP).

Finazzi G; low-dose aspirin in polycythemia (ECLAP).

Division of Hematology, Ospedali Riuniti, Largo Barozzi 1, 24128 Bergamo, Italy. [email protected]
Abstract

BACKGROUND: - The clinical course of polycythemia vera (PV) is often complicated by arterial and venous thrombosis. Current information on these vascular complications derives from very few prospective clinical trials and several retrospective studies. The purpose of this analysis is to report the incidence, clinical features and risk factors for thrombosis in a large number of patients prospectively followed in a multicountry European study. METHODS: - The European collaboration on low-dose aspirin in polycythemia vera (ECLAP) study is a multicenter project aimed at describing the natural history of PV. Overall, 1630 PV patients (57% males, median age at recruitment 65 years) were enrolled in the study. Five hundred and eighteen (32%) of these patients are entered into a parallel, double-blind, placebo-controlled, randomized clinical trial aimed at assessing the efficacy and safety of low-dose aspirin. The remaining 1112 (68%) are entered into an ongoing, observational, prospective, cohort study. The mean follow-up duration was 2.7 years (range 0-5.3). FINDINGS: - The cumulative incidence rate of cardiovascular events (i.e. cardiovascular death and non-fatal thrombotic events) was 5.5 events/100 persons per year. Thrombosis was the main cause of death. Age greater than 65 years and positive history of thrombosis were the two most important predictors of cardiovascular events. Smoking, hypertension and congestive heart failure were other significant risk factors for thrombosis. Platelet counts and myelosuppressive drugs were not associated with the risk of cardiovascular events. Antiplatelet therapy was the only variable associated with a lower risk of thrombosis. CONCLUSION: - Cardiovascular events remain a major cause of mortality and morbidity in PV but the thrombotic risk seems to be more related to the patients' characteristics (age, previous thrombosis, cardiovascular risk factors) than to the disease itself. Thus, control of red cell mass and antithrombotic therapy appear to be effective treatments in limiting the risk of thrombosis.

 

[aflo]

WHAT HE SAID....jk... coumadin and aspirin are both used in order to thin blood and.. mainly coumadin interferes with hepatic synthesis of vitamin k. Vitamin k plays a role in the body to independently clot... With that interference of thinning blood H/H can be increased. JUs a side note too watch foods high in vit k cause thats the antidote for coumadin. Hope this helps.. sorry sometimes I ramble about bs. I work in the ER as a registered nurse.

 

[maldorf]

WHAT HE SAID....jk... coumadin and aspirin are both used in order to thin blood and.. mainly coumadin interferes with hepatic synthesis of vitamin k. Vitamin k plays a role in the body to independently clot... With that interference of thinning blood H/H can be increased. JUs a side note too watch foods high in vit k cause thats the antidote for coumadin. Hope this helps.. sorry sometimes I ramble about bs. I work in the ER as a registered nurse.

I dont understand why everyone keeps saying that these drugs "thin" the blood. Like you say, Coumadin works by inactivating vitamin k which is used in the formation of several of those factors in the clotting cascade I keep talking about." Low dose aspirin reduces the 'stickiness' of platelets. This helps to stop platelets sticking to a patch of atheroma and forming a blood clot." So neither is making your blood less viscous(thick).

Being on coumadin you do need to keep a consisten diet in order to keep your INR in range. Mine is supposed to be between 2 and 3 and Im have an east time of that. I check mine just once a month. Foods rich in vitamin K can lower your INR, but I must eat a consistent level of those foods because my INR never differs too much.

I could not find anywhere a reference that says that either of these drugs can raise your hemoglobin. Its not like these drugs reduce your blood volume, like when you are dehydrated. They do not have an effect on hct/hgb levels unless a patient is suffering internal bleeding. Internal bleeding would lower your hgb levels, and it does appear sometimes in some patients from what I could gather online.

Maybe Im missing something?

 

[aflo]

sorry maldorf but the term "blood thinners" when we refer to blood is not in actuality thinning the blood out but just a term we use in the hospital to pt. on phrophylaxis, which are in fact considered blood thinners in the hospitals i,e coumadin, aspirin, etc. It doesnt actually thin ur blood and sorry for not saying that. and yes maintain your vitamin k levels. b/c vitamin k is actually the antidote to coumadin. But you are right when someone is recieving prophylaxis therapy we are mainly concerned with decreased H/H.. but pt on these therapies often have an Increased h/h, sorry for not clarifying this but a slightly elevated H/H not something to worry about. In some pt it is slightly elevated due to acute injury and disease process, mainly heart disease, and this probably inversely reflects the fact that these pt. are on these two therapies. Well i do hope this helps. I had to ask the on call dr. here at work for this one.... LOL.. hope this helps maldorf.

 

[maldorf]

sorry maldorf but the term "blood thinners" when we refer to blood is not in actuality thinning the blood out but just a term we use in the hospital to pt. on phrophylaxis, which are in fact considered blood thinners in the hospitals i,e coumadin, aspirin, etc. It doesnt actually thin ur blood and sorry for not saying that. and yes maintain your vitamin k levels. b/c vitamin k is actually the antidote to coumadin. But you are right when someone is recieving prophylaxis therapy we are mainly concerned with decreased H/H.. but pt on these therapies often have an Increased h/h, sorry for not clarifying this but a slightly elevated H/H not something to worry about. In some pt it is slightly elevated due to acute injury and disease process, mainly heart disease, and this probably inversely reflects the fact that these pt. are on these two therapies. Well i do hope this helps. I had to ask the on call dr. here at work for this one.... LOL.. hope this helps maldorf.

Yeah, the whole point of this thread, why I created it, was to bring to people's attention that hematocrit/hemoglobin can be elevated for many reasons and to not assume that yours is elevated entirely because of your taking steroids. In my case now, heart disease has raised mine. My hematocrit runs about 54 now all of the time. He has decided to keep it there but if it gets much higher its time to bleed!

Yeah, a patient that is on coumadin and aspirin stands a real good chance of having a high hematocrit/hemoglobin because they probably have some kind of cardiovascular disease which will raise it. Its not the drugs that are raising it. Now the drugs can lower it if youre bleeding inside, and thats damn scary.

 

[mitochondria]

my grandma thats in her 80's is on coumidin, its actualy a rat poison, good luck with everything

 

[Medic08]

The thing that confuses me is your EPO levels are low, but your RBC is higher than normal. The adrenal gland is what produces erythropoeiten which produces more RBC's. Makes no sense to me. Have they checked a possible addrenal gland problem?

 

[maldorf]

my grandma thats in her 80's is on coumidin, its actualy a rat poison, good luck with everything

Yeah, Im a rat. My wife told me so! It is not as bad as it sounds. Ive not had a single side effect yet and ive been on it for about 1 year or so. Its been real easy and gives me piece of mind. Only thing that scares me is if I were to get into a bad car accident, I would bleed a lot fast. They do give vitamin K I believe as an antidote though. I suppose I could grab some raw broccoli and chew away.

 

[Medic08]

And yes stuff like asprin and plavix are anti-agrigants as opposed to anti-coagulants.