The terms polycythaemia and erythrocytosis are used by doctors if you have a high red blood cell count. Polycythaemia is an abnormally high concentration of hemoglobin in the blood through an increase in red cell numbers, whereas erythrocytosis only refers to a documented increase of red cell mass. The number of red cells you have varies according to sex and age. Women have lower levels than men and newborn babies often will have more than adults.

Normal Range of Red Blood Cell Count

Normal red blood cell ranges of various ages are:

• Adult males: 4.7 to 7.2  million/microliter
• Adult females: 4.2 to 5.0 million/microliter
• Children: 3.8 to 5.5 million/microliter
• Newborns: 4.8 to 7.2 million/microliter
• Pregnancy: Slightly lower than normal adult cell counts

If you exceed the upper limit of your range, you may have a high blood cell count.

Symptoms of Having High Red Blood Cell Count

Mild cases of polycythaemia might not cause any symptoms, but common symptoms can include:

• Chest pain
• Muscle pain
• High blood pressure
• Headaches
• Dizziness
• Ringing in the ears
• Blurred vision
• Ruddy complexion
• ltching

If polycythaemia is related to liver cancer, kidney cancer, or other erythropoietin secreting tumors, the symptoms can include abdominal pain or fullness, weight loss, and jaundice (yellowing of the skin).

Why Do You Have High Blood Cell Count?

The causes of polycythemia can be primary or secondary. In primary polycythemia, abnormalities in the production of red blood cells cause a high red blood cell count. The cause of secondary polycythemia is the result of external factors such as sleep apnea, hypoxia, and certain tumors, affecting red blood cell production.

1. Causes of Primary Polycythemia

Primary polycythemias are abnormally high levels of red blood cell precursors resulting from inherited or acquired genetic mutations. This category also includes polycythemia vera, and primary familial and congenital polycythemia.

• Polycythemia vera

Polycythemia vera is a relatively rare condition, and is typically associated with an elevated white blood cell count and platelet count. An enlarged spleen and low erythropoietin levels are other clinical features of polycythemia vera. The exact cause of polycythemia vera is not well understood. However, medical experts have found that genetic mutations are responsible for most cases. These mutations are thought to possibly increase the sensitivity of the red blood cell precursors to erythropoietin, thus increase red blood cell production.

• Primary familial and congenital polycythemia

Genetic mutations are also thought to cause primary familial and congenital polycythemia. This results in an increased responsiveness to normal levels of erythropoietin. Many cases are caused by different mutations in the erythropoietin receptor gene.

2. Causes of Secondary Polycythemia

Long-term exposure to low oxygen levels or suffering from an erythropoietin secreting tumor can cause secondary polycythemia. A lack of oxygen or secreting tumor can cause your body to make more of the hormone erythropoietin, and high levels of EPO can prompt your body to make more red blood cells than normal.

• Chronic hypoxia

Conditions that cause chronic hypoxia such as chronic bronchitis, sleep apnea, chronic heart diseases, and emphysema are known as chronic obstructive pulmonary disease (COPD). Additionally, people who live in high altitudes may develop polycythemia. At high altitudes, increased red blood cell production occurs in order to compensate for the low oxygen levels and low level tissue oxygenation.

• Erythropoietin secreting tumors

Certain tumors often release increased amounts of erythropoietin. The more common erythropoietin secreting tumors are kidney cancer, liver cancer, adrenal adenoma, and uterine tumors. Sometimes, a kidney obstruction or noncancerous kidney cysts may also secrete more erythropoietin and cause polycythemia. A rare hereditary genetic condition can cause an increased activity of the gene that produces erythropoietin, and the overproduction can cause polycythemia.

Diagnose High Red Blood Cell Count

Your medical history, a physical examination and a series of tests are used to decide if and why a patient has an erythrocytosis, such as:

• Blood test for an increase in red cell numbers.
• Physical examination is performed to look for signs of possible underlying disorders.
• Red cell mass study that is often carried out in a hospital's nuclear medicine department.
• Vitamin measurement such as iron, folic acid and vitamin B12, which are all important in red cell production.
• Oxygen levels to measure oxygen levels in the blood, usually with a probe clipped onto your finger.
• Lung function test for COPD.
• Oxygen dissociation to measure how tightly hemoglobin holds on to oxygen.
• Urine test for the presence of blood, sugar or other abnormality.
• Chest X-ray to check that the lungs and heart appear normal.
• Ultrasound of the abdomen to check the kidneys, liver and for any increase in the size of the spleen or fibroids in the womb.
• Kidney and liver function tests for normal functionality.
• Bone marrow sample that is performed under local anesthetic.
• Echocardiogram to examine the structure of the heart.
• Genetic testing for mutations common in polycythaemia vera, and the erythropoietin receptor.
• Sleep study if a condition called sleep apnea is suspected.

What Are the Treatments of High Red Blood Cell Count?

1. Medical Treatments

• Phlebotomy

Phlebotomy is the quickest and simplest way of reducing your red blood cell count, and it may be recommended if you have a history of blood clots. Phlebotomy involves removing about a pint of blood at a time, similar to the procedure used for blood donation. How often this is required will be different for each person.

• Medication to decrease red blood cell production

Medication may be prescribed to slow down the production of red blood cells. Your physician will take into account your age and health, response to phlebotomy and high red blood cell count when choosing the most appropriate medication for you. Examples might include hydroxycarbamide or interferon.

• Medication for blood clot prevention

Daily low-dose aspirin tablets can be prescribed to help prevent blood clots and reduce the risk of serious complications. You may also be offered treatment with low-dose aspirin if you are in other conditions affecting your blood vessels, such as cerebrovascular disease and coronary heart disease.

2. Home Remedies

Some simple measures can be taken at home to control potential symptoms and avoid possible complications for people with polycythemia, including:

• Staying well hydrated to avoid concentrating the blood even further through dehydration. Generally speaking, there are no restrictions on physical activity.
• If you have an enlarged spleen, contact sports should be avoided to prevent injury and rupture.
• Avoid iron supplements because this can promote more red blood cell production and a high red blood cell count.