High Haemoglobin, and HCT, don't know what to do...

[edoos]

Hi Guys,

I have been always pretty high on Haemoglobin and HCT since I'm young. it fluctuates from 16-17,5 and HCT from 46-49. I'm now older and at 17,9 HB and 52% HCT. I have seen 2 haematologists who are not worried about my result and said I'm not qualifying for PV and didn't want to test further. The issue is I have symptoms since a long time that I attribute to stress like being dizzy during the day while doing something and with being tired/weak all the time. I have seen that could be some symptoms of PV and I would like to know if there is something I could do expect Blood letting to lower my haemoglobin like supplements or anything's else. I start pomelo to lower HCT, recently.

Here are my result, it's in French, but I assume you will understand. Thanks for your help, guys. Would be interested to have your opinions @Hans as I found all of your post really helpful.

 

[youngsinatra]

Did you ever tested your total iron-saturation index or ferritin?

 

[edoos]

Did you ever tested your total iron-saturation index or ferritin?

Yes, I have always been high around 56% for saturation, 190 for iron and 280 for ferritin. I have been tested for haemochromatosis and I don't have a gene variant. I recently start a turmeric highly bioavailable supplement who for the first time in 10y bring down my saturation to normal level 36% and iron level to 120 but ferriting still high at 245. thanks for your help

 

[youngsinatra]

Yes, I have always been high around 56% for saturation, 190 for iron and 280 for ferritin. I have been tested for haemochromatosis and I don't have a gene variant. I recently start a turmeric highly bioavailable supplement who for the first time in 10y bring down my saturation to normal level 36% and iron level to 120 but ferriting still high at 245. thanks for your help

You don’t need to have the hemachromatosis gene to possibly have iron overload as far as I know.

I‘d donate blood regularly. (Every 2-3 months) It‘s the best thing for lowering iron. I know someone who had their ferritin in the 700s and is now down to 50, just by donating blood regularly. He also does not have the gene that predisposes one to iron overload.

 

[edoos]

You don’t need to have the hemachromatosis gene to possibly have iron overload as far as I know.

I‘d donate blood regularly. (Every 2-3 months) It‘s the best thing for lowering iron. I know someone who had their ferritin in the 700s and is now down to 50, just by donating blood regularly. He also does not have the gene that predisposes one to iron overload.

Do you think by lowering my iron it will lower also my HB and HCT ?

 

[youngsinatra]

Do you think by lowering my iron it will lower also my HB and HCT ?

Definitely. Bodybuilders often donate blood to lower their Hb, that is increased by androgenic steroid use.

 

[Beastmode]

My hemoglobin was around the same and ferretin levels as well. Some say a saturation of 60% and more is a sign of significant oxidative stress.

I started blood donations this past month and will continue every 2-3 months as well. Definitely makes a difference.

 

[aniciete]

You don’t need to have the hemachromatosis gene to possibly have iron overload as far as I know.

I‘d donate blood regularly. (Every 2-3 months) It‘s the best thing for lowering iron. I know someone who had their ferritin in the 700s and is now down to 50, just by donating blood regularly. He also does not have the gene that predisposes one to iron overload.

What’s a good ferritin level?

 

[edoos]

My current range say a ferritin level till 350 is normal, but I have read only numerous time that over 200 it's already to much... So i don't know what to trust my lab range or my doctor or interent. My doc said it's also okay at 250

 

[Beastmode]

My current range say a ferritin level till 350 is normal, but I have read only numerous time that over 200 it's already to much... So i don't know what to trust my lab range or my doctor or interent. My doc said it's also okay at 250

Morley Robbins says 20 is ideal and a doctor he quoted said down to 0 is even better.

Without the full picture, one range is probably not reason enough to change it.

 

[yerrag]

Hi Guys,

I have been always pretty high on Haemoglobin and HCT since I'm young. it fluctuates from 16-17,5 and HCT from 46-49. I'm now older and at 17,9 HB and 52% HCT. I have seen 2 haematologists who are not worried about my result and said I'm not qualifying for PV and didn't want to test further. The issue is I have symptoms since a long time that I attribute to stress like being dizzy during the day while doing something and with being tired/weak all the time. I have seen that could be some symptoms of PV and I would like to know if there is something I could do expect Blood letting to lower my haemoglobin like supplements or anything's else. I start pomelo to lower HCT, recently.

Here are my result, it's in French, but I assume you will understand. Thanks for your help, guys. Would be interested to have your opinions @Hans as I found all of your post really helpful.

RBC Hemoglobin Hematocrit very high based on functional medicine reference range of Dr. Weatherby.

Eosinophils very high.
Monocytes at high range of normal.

However MCV, MCH, and MCHC are all within range so it doesn't seem like you have signs of anemia of chronic disease, or too much hemoglobin in relation to red blood cells.

Your platelet count and platelet volume is normal as well.

Ferritin is high and serum iron high. Iron saturation at 36 may be within range but you should also check transferrin saturation as sometimes transferrin saturation could be higher- to confirm if you have hemochromatosis and need to donate blood.

If there is no hemochromatosis confirmed, then you will need to consider whether you high rbc hgb hct values are due to low blood volume.

Low blood volume makes many concentration- based blood markers appear higher than they really are. As really what is being determined is not concentration but absolute amount of cells or molecules or substances in circulation and concentration is a proxy for absolute amount.

For example, if normal blood volume is 5 liters and you only have 4 liters of blood, you have low blood volume.

And if your rbc says you have 6x rbc/ml, it really should be converted to you having 6 (4/5)=4.8X rbc/ml. So from thinking you have too much rbc, you now realize enough rbc (based on normal range 4.2 - 4.9 if you're male ).

Because your RBC RGB HCT are all very high but your MCH and MCHC are normal, it could very well mean that you have low blood volume.

And if we can confirm you have low blood volume, it means a lot of concentration-based absolute (not percentage) markers have to be adjusted as well. Such as wbc and creatinine.

However, it's not as straightforward to determine if you have low blood volume and if so, by how much you are low in blood volume.

An important protein that's key to determining your blood volume is albumin. If your liver produces too little albumin, it could lead to low bv. If you use a lot of albumin as an antioxidant to protect your tissues from oxidative stress, it could lead to low bv. Albumin attracts sodium chloride and holds on to it, and sodium attracts water from the interstitial fluids to increase plasma volume, and this increases blood volume.

Most doctors are formulaic and don't use simple math and logic even though they studied math and logic before they pass high school. That is the design imho of medical education to intentionally dumb them down. Now enough of my soapbox.

If your liver is healthy and you eat enough protein, you should be making enough albumin. And chances are that you are.

If you're using too much albumin more than your liver is producing as an antioxidant, you will have low blood volume. The oxidized albumin will have no where to go but to be excreted in urine.

You can measure your urine albumin excretion using the urine ACR test. But to get an idea if you need to take that test, you can check to see if your urine is foamy when you urinate. And if you urinate often, there is a stronger case you are urinating oxidized albumin a lot.

But what I say isn't conclusive. I'm limited to my own experience and research. There are other connections and causes.

But I hope I gave you some ideas to work with that your doctors as usual may not be able to provide.

Lastly, don't delegate your health to doctors as they did a poor job delegating their education to filthy big pharma.

 

[edoos]

Thanks for your detailed answer. I actually tested for HH gene and they both came out negative. My previous saturation was high 56% I bring it down with tumeric. I actually have high Albumin, as you can see here.

 

[yerrag]

Thanks for your detailed answer. I actually tested for HH gene and they both came out negative. My previous saturation was high 56% I bring it down with tumeric. I actually have high Albumin, as you can see here.
View attachment 36291

It is on the high range of normal. So even with low blood volume, your albumin, say adjusted by 20%, would still be within range.

Just to be sure, are you waking up to urinate at night? If so, how often? Is urine foamy? And if it is, does it quickly disappear? I want to rule out the possibility you are losing albumin thru urination.

If albumin isn't the issue, and you don't have low blood volume, then we'd have to look into why you're making a lot of red blood cells and you have a higher than normal hemoglobin concentration.

I forgot to ask what you meant by PV in your OP.

 

[aliml]

Aspirin reduces the levels of hematocrit and ferritin.

Low-dose Aspirin can safely prevent thrombotic complications in patients with Polycythemia Vera who have no contraindications to such treatment.

Efficacy and safety of low-dose aspirin in polycythemia vera - PubMed

Low-dose aspirin can safely prevent thrombotic complications in patients with polycythemia vera who have no contraindications to such treatment.

pubmed.ncbi.nlm.nih.gov

 

[yerrag]

OP probably given up on this thread.

But if OP hasn't, I'll share that I used to have hemachromatosis, and I donated blood because of it.

Back then, I had mercury toxicity.

Mercury displaces oxygen in hemoglobin.
Makes blood carry less oxygen. This is called hypoxemia. Not hypoxia.

I didn't have an oximeter before, but I imagine my oximeter would have lower spO2 because of hypoxemia.

The body may make more RBCs and hemoglobin to compensate by increasing erythropoetin production in the kidneys, to tell the bone marrow to produce more of them.

But I'm not certain of this because I didn't keep records then. I have no record of my CBC dating to that time.

After I fixed my mercury toxicity thru removal of silver fillings in my mouth followed up by a series of IV chelation of mercury, I no longer had hemochromatosis. I don't know why.

OP can do some research and think for himself rather than look for doctors with answers. That's like finding a needle in a haystack.

 

[Blue Water]

OP probably given up on this thread.

But if OP hasn't, I'll share that I used to have hemachromatosis, and I donated blood because of it.

Back then, I had mercury toxicity.

Mercury displaces oxygen in hemoglobin.
Makes blood carry less oxygen. This is called hypoxemia. Not hypoxia.

I didn't have an oximeter before, but I imagine my oximeter would have lower spO2 because of hypoxemia.

The body may make more RBCs and hemoglobin to compensate by increasing erythropoetin production in the kidneys, to tell the bone marrow to produce more of them.

But I'm not certain of this because I didn't keep records then. I have no record of my CBC dating to that time.

After I fixed my mercury toxicity thru removal of silver fillings in my mouth followed up by a series of IV chelation of mercury, I no longer had hemochromatosis. I don't know why.

OP can do some research and think for himself rather than look for doctors with answers. That's like finding a needle in a haystack.

I have high-normal serum iron, high transferrin saturation (47-52% normally but has been as high as 70%), ferritin is around 30-50 normally but last I checked it went up to 96. However I was also in an acute inflammatory episode with high CRP and ESR, so I take that ferritin with a grain of salt. I have one hemochromatosis gene. My hematologists did not think I had hemochromatosis likely because the ferritin level was low. I tend to have high-ish RBC (5.2-5.6) and high-ish hematocrit (46-48%) but MCH and MCHC are typically in the normal range.

Last week I was diagnosed with a DVT as a result of what I believe to be a combination of dehydration, a long flight, and an infection or inflammatory episode of some kind. This has made me return to the hypothesis that my blood is clotting and generating too many red blood cells, potentially because of iron.

I am wondering if I have polycythemia vera or if it was just dehydration, but in general I think the iron is the issue. Phlebotomy seems like the most straightforward solution to my problems, I am frankly just nervous to get it in the country I live in.

 

[AgentCranberry]

My current range say a ferritin level till 350 is normal, but I have read only numerous time that over 200 it's already to much... So i don't know what to trust my lab range or my doctor or interent. My doc said it's also okay at 250

To understand this, you have to keep in mind the standard procedure for setting a reference range: You take a healthy population (and we can already start here: what is healthy?), test them for a marker and then take the central 95% of the values (meaning you sort out the lowest and highest 2.5% of the values, the rest is your reference range now).

While this can work well for certain parameters, "normal" does not mean optimal here. As others already pointed out, to the liking of many "alternative" physicians, 250 is too high. "Exposing the Hidden Dangers of Iron" by E.D. Weinberg is supposed to be a very good read in this regard (is still on my to read list).

And thank you @yerrag for your info about the connection between iron and mercury toxicity, very interesting!

 

[yerrag]

I have high-normal serum iron, high transferrin saturation (47-52% normally but has been as high as 70%), ferritin is around 30-50 normally but last I checked it went up to 96. However I was also in an acute inflammatory episode with high CRP and ESR, so I take that ferritin with a grain of salt. I have one hemochromatosis gene. My hematologists did not think I had hemochromatosis likely because the ferritin level was low. I tend to have high-ish RBC (5.2-5.6) and high-ish hematocrit (46-48%) but MCH and MCHC are typically in the normal range.

Last week I was diagnosed with a DVT as a result of what I believe to be a combination of dehydration, a long flight, and an infection or inflammatory episode of some kind. This has made me return to the hypothesis that my blood is clotting and generating too many red blood cells, potentially because of iron.

I am wondering if I have polycythemia vera or if it was just dehydration, but in general I think the iron is the issue. Phlebotomy seems like the most straightforward solution to my problems, I am frankly just nervous to get it in the country I live in.

Your ferritin seems to say there is no significant infection on-going. The high serum iron and iron/transferrin saturation seems to point towards an inability to use iron to make more rbc and hemoglobin.

And though your rbc and hematocrit appears normal, it may be that dehydration (their code word for low blood volume) makes them appear higher than what they really are (many blood markers are concentration based and low blood volume makes for higher concentrstion).

What is your cbc hemoglobin?

A ceruloplasmin test would give you your copper status, low copper affects the ability to produce blood.

You mention inflammation, and I assume they are metabolic-based as the low ferritin disposes me to think of it that way. As ferritin would rise, serum iron lower, and saturation be lower, to keep available iron low to keep microbes from multiplying.

Of course, this is just my initial guess given the many factors involved that we dont know about. Like what really is behind your DVT.

If low blood volume exists, phlebotomy isn't a solution.

Recently, I heard about pulse pressure being inversely related to blood volume. Not sure if it's well-validated. What is your pulse pressure?

 

[yerrag]

@AgentCranberry you're welcome!

 

[Blue Water]

Your ferritin seems to say there is no significant infection on-going. The high serum iron and iron/transferrin saturation seems to point towards an inability to use iron to make more rbc and hemoglobin.

And though your rbc and hematocrit appears normal, it may be that dehydration (their code word for low blood volume) makes them appear higher than what they really are (many blood markers are concentration based and low blood volume makes for higher concentrstion).

What is your cbc hemoglobin?

A ceruloplasmin test would give you your copper status, low copper affects the ability to produce blood.

You mention inflammation, and I assume they are metabolic-based as the low ferritin disposes me to think of it that way. As ferritin would rise, serum iron lower, and saturation be lower, to keep available iron low to keep microbes from multiplying.

Of course, this is just my initial guess given the many factors involved that we dont know about. Like what really is behind your DVT.

If low blood volume exists, phlebotomy isn't a solution.

Recently, I heard about pulse pressure being inversely related to blood volume. Not sure if it's well-validated. What is your pulse pressure?

Hemoglobin ranges from 15.2 to 16.5 so it can be elevated as well. Is this a concentration based value?

In the past I have had low ceruloplasmin, low urine copper output, as well as low-ish serum copper, but my last tests (done a year ago) showed normalization in the ceruloplasmin and urine copper to some extent. Haven't re-tested serum copper values yet. The thing is my hair tests showed super high copper so I did not want to supplement it. I assume its a metabolic problem in using copper.

However, you say that ceruloplasmin is needed to produce blood – do you really think low blood is the issue? It looks like my blood is very thick. Or are you saying that in fact my blood volume is low and thus the numbers only make it appear to be thick?

I did hijama (substitute for phlebotomy) a while back and felt very weak after that experience, which made me wonder if phlebotomy was actually a good thing for me. My last blood pressure test was 130/70 and I would guess that's about average for me, that would put pulse pressure at 60 which is high.

Do you think this is an indication of low volume? If so what is the correction for volume besides hydration? You mentioned albumin, so if the body over-uses albumin the blood volume will be low. On the other hand, if there is ample albumin the blood volume will be normal. My blood tests typically show high-normal albumin levels and actually the albumiin-globulin ratio is usually a bit elevated. So this suggests my liver produces ample albumin, and there is ample albumin in the serum. In my case this would not point to low volume, is that right?