routine bloodwork - HCT and RBC high

[M@NU]

Hi guys,

i just had my routine bloodwork which i have every 10-12 weeks due to my heart insufficiency, electrolytes etc.
3 things jumped into my eye this time where i would like to have your advise:
HCT - 55% --> probably due to the high use of diuretics?
RBC - 6,2
Creatinine 1,3

my last bloodwork was at the end of august. Creatinine was around 1 back then, hct at 51, rbc at 6,0
what changed since then:
- entresto dosage increased
- jardiance new medication
- 5mg more torsemid
- TRT from gel only to 120mg a week split in 2 shots.


now i am thinking of dropping my TRT back down to 60-70mg to bringt HCT and RBC back down since i have a feeling they contribute to shortness of breath in my situation.
--> is it likely dropping down to 60mg will lower those?
I am not allowed donating blood since i was in hospital in the last 6 months which excludes me.
Doing my by myself i do not have the balls for.
thanks guys!

 

[Delt123]

You can try Emeric’ protocol. Seems like many have done it with good results in regards to lowering hematocrit/RBC. I have no experience with it but it’s maybe something I’d do later down the road.

 

[M@NU]

thanks.
Ive decided to go down to 20mg eod yesterday.
But i assume it wont bring down the hct and rbc any time soon, correct?

 

[Matsuo Munefusa]

thanks.
Ive decided to go down to 20mg eod yesterday.
But i assume it wont bring down the hct and rbc any time soon, correct?

it will take about a month in my experience to start to see a drop. but I imagine you could get a drop quicker if you really stepped up your hydration/electrolyte protocol.

Good luck.

55% isn't terrible though. I am regularly 53-55% and I function just fine with BP, HR, etc.

 

[Dipp20]

Since I'm on 15mg/ed my rbc and hk dropped significantly. My estradiol as well and almost dropped too low. I would try to do ed injections, they help.

 

[M@NU]

it will take about a month in my experience to start to see a drop. but I imagine you could get a drop quicker if you really stepped up your hydration/electrolyte protocol.

Good luck.

55% isn't terrible though. I am regularly 53-55% and I function just fine with BP, HR, etc.

hey, thanks for your reply.
i think in my case (weak heart) it is wiser to have hct/rbc lower, especially since i already have episodes with shortness of breath..i believe the higher end of the range for hct and rbc doesnt make it better (but the opposite)
hydration is also an issue.. i was always drinking large amounts of fluid (6-7 litres a day i would say). now with my heart insufficiency, docs told me to keep it to 2-2.5litres, 3 litres if i am very active. not more .. im always thirsty but i am not sure if i can drink more without doing more damage or having to increase my diuretics

 

[maldorf]

thanks.
Ive decided to go down to 20mg eod yesterday.
But i assume it wont bring down the hct and rbc any time soon, correct?

Yes, it will take a long time. I'd say at least 2 months to really do much.

 

[M@NU]

Yes, it will take a long time. I'd say at least 2 months to really do much.

i definitely have to see if there is any way to get it done by some medical staff then..
I also thought about doing it by myself if noone wants to help but i am not sure if i have the balls for that..

 

[Kaladryn]

You can try Emeric’ protocol. Seems like many have done it with good results in regards to lowering hematocrit/RBC. I have no experience with it but it’s maybe something I’d do later down the road.

I also highly recommend 10mg/day.

FYI crit will naturally go up if your heart is compromised.

 

[maldorf]

i definitely have to see if there is any way to get it done by some medical staff then..
I also thought about doing it by myself if noone wants to help but i am not sure if i have the balls for that..

Don't do it on your own. Might have been just coincidence, but a few days after I did my own I had the big heart attack.

 

[nicocujo]

I drink this sometimes to hydrate myself because I never drink enough water.

https://www.amazon.com/dp/B01IT9NLHW?ref=ppx_yo2_dt_b_product_details&th=1

 

[Rudygreg]

I would consider this a secondary polycythemia. What's your hgb? Have you checked your ferritin or iron levels?

 

[M@NU]

I would consider this a secondary polycythemia. What's your hgb? Have you checked your ferritin or iron levels?

HB was 17,1
ferritin and iron were not checked
@Kaladryn:
yeah, i also thought about that since it should be linked to o2 saturation etc and mine is not as good as it should be, esp in the night.
I have a appointment at a lung doctor friday in 2 weeks to make a sleep study over the weekend and see where i am. Afterwards, we will
make the sleep study in their facility. I really hope that i get something that helps me get through the night without breathing issues
(maybe oxygen or whatever?)

 

[Rudygreg]

Sounds like you have sleep apnea which due to the lack of oxygen could be causing your body to produce more RBCs because of this. I think seeing the Pulmonologist is your best bet. I've done many therapeutic phlebotomies and ended up draining my iron stores. We also see this condition in smokers, clients that use PEDs, and hemochromatosis.

 

[M@NU]

Sounds like you have sleep apnea which due to the lack of oxygen could be causing your body to produce more RBCs because of this. I think seeing the Pulmonologist is your best bet. I've done many therapeutic phlebotomies and ended up draining my iron stores. We also see this condition in smokers, clients that use PEDs, and hemochromatosis.

so your suggestion would be to check iron/ferritine before trying to get a phlebotomy?
What i also have is MCH and MCHC value that are both slightly under the range
(MCH 26pg, MCHC 30.1 g/dl).
for HB i rechecked. 17,1 was not correct, it is 16,4
not sure how to interpret the MCH and MCHC value?

 

[Dipp20]

Low MCH and MCHC can be caused by low ferritin.

 

[Rudygreg]

Sounds like you have sleep apnea which due to the lack of oxygen could be causing your body to produce more RBCs because of this. I think seeing the Pulmonologist is your best bet. I've done many therapeutic phlebotomies and ended up draining my iron stores. We also see this condition in smokers, clients that use PEDs, and hemochromatosis.

so your suggestion would be to check iron/ferritine before trying to get a phlebotomy?
What i also have is MCH and MCHC value that are both slightly under the range
(MCH 26pg, MCHC 30.1 g/dl).
for HB i rechecked. 17,1 was not correct, it is 16,4
not sure how to interpret the MCH and MCHC value?

Correct dipp, MCHC is the concentration of the RBCs which is low so phlebotomy would probably push you even lower. I would be curious to see where ferritin,iron,tibc is before anything. Sleep study is gonna be helpful regardless. Are you taking aspirin?

 

[M@NU]

Sounds like you have sleep apnea which due to the lack of oxygen could be causing your body to produce more RBCs because of this. I think seeing the Pulmonologist is your best bet. I've done many therapeutic phlebotomies and ended up draining my iron stores. We also see this condition in smokers, clients that use PEDs, and hemochromatosis.

Correct dipp, MCHC is the concentration of the RBCs which is low so phlebotomy would probably push you even lower. I would be curious to see where ferritin,iron,tibc is before anything. Sleep study is gonna be helpful regardless. Are you taking aspirin?

no i am not taking aspirin or any blood thinners.
I do take:
3AM + 2PM torsemide 5mg
25mg eplerenone AM
10mg Jardiance AM
8,75mg Nebivolol AM
and i should take the maximum dosage of entresto 2x daily but ive swapped entresto to candesartan because i feel worse when i am on entresto
so right now 16mg AM 8mg PM candesartan

would you suggest 1-2 baby aspirin daily? i should have a pack somewhere from old ECA days

yeah, i also hope the sleep study will bring results and i get additional help..
just incase i get blood drawn this week:
what os "tibc"?
ferritin and iron are known.
thanks for your help buddy!!

 

[Rudygreg]

81 MG Aspirin isn't gonna hurt just make sure it's enteric coated or it will ruin your gut.

 

[maldorf]

HB was 17,1
ferritin and iron were not checked
@Kaladryn:
yeah, i also thought about that since it should be linked to o2 saturation etc and mine is not as good as it should be, esp in the night.
I have a appointment at a lung doctor friday in 2 weeks to make a sleep study over the weekend and see where i am. Afterwards, we will
make the sleep study in their facility. I really hope that i get something that helps me get through the night without breathing issues
(maybe oxygen or whatever?)

Might need a CPAP. I once tried doing a sleep study but because I'm such a picky sleeper, I couldn't sleep well in their bed. You also have to wear a lot of apparatuses that make it hard to sleep. My study was inconusive, but they offered to prescribe a CPAP. I didn't get one.