FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

POLYCYTHEMIA: TOO MUCH OF A GOOD THING

Question: My brother-in-law has polycythemia. He gives blood regularly to control his condition. Is this the only therapy? I'm concerned because my home medical book says giving blood too often is bad for your health.

Answer: Polycythemia is a condition in which a person has more red blood cells than normal, and it can be caused by many different illnesses. In this condition, the increased number of red cells make the blood more viscous, or "sticky" than it should be. Polycythemia which some people refer to as having "thick blood" hampers the blood's ability to carry oxygen and nutrients to all of the cells of the body.

Lack of proper levels of oxygen in various parts of the body can cause a myriad of symptoms. Headaches, dizziness and visual problems are often present. Mild exercise is tiring. Bleeding from minor injuries frequently develops, and liver, kidneys and spleen abnormalities are quite common as well.

Polycythemia can be divided into two groups. The first, a type of cancer called polycythemia vera, causes an absolute increase in the number of red blood cells. The other more common type is known as secondary polycythemia, and it results from a reduced volume of blood. This creates an apparent increase in the number of red blood cells. About 5 percent of newborn babies, and a higher percentage of those born to diabetic mothers, have this condition. Secondary polycythemia also includes cases where the number of red blood cells increases in response to a high level of the hormone erythropoietin.

I think it is safe to assume that your brother-in-law is no longer a baby, but he could have one of the kinds of secondary polycythemia that afflict adults. Lung disease, living at high altitudes, certain types of heart disease and smoking are common causes. Cancers of the liver, kidneys, adrenal glands and ovaries are often responsible, as are large uterine fibroid tumors, or undergoing a renal transplant. In these secondary causes of polycythemia, treatment is directed at the underlying illness rather than at the symptom of increased blood cells. However, it is occasionally necessary to remove blood phlebotomy in medical jargon to temporarily help control symptoms while treatment for the underlying disease is underway.

I don't have sufficient information about your brother-in-law to be certain about the cause of his polycythemia. However, I think it is a good bet that since his doctor has recommended phlebotomy as the best treatment, he has the condition I mentioned earlier called polycythemia vera.

Polycythemia vera is a cancer of the red blood cell forming mechanism of the bone marrow. The creation of new blood cells is not influenced by the hormone erythropoietin in this disease. They are made just as fast as the "wild and uninhibited" cancer cells can go.

Polycythemia vera is a serious illness. Without treatment, the average survival time is two years. Fortunately, with treatment the survival time is no different than it is for someone without the disease. And the treatment for it is removal of a pint of blood every two weeks until the concentration of cells within the blood is reduced to normal. Once the normal concentration is reached, the prescribed "bloodletting" is done less frequently. In some individuals, three or four times a year may be all that is needed. In a few individuals it may be necessary to use one of several anti-cancer medications to help slow the production of blood cells along with periodic phlebotomy.

There is no need to worry for your brother-in-law because of these frequent phlebotomies. His body makes more blood cells than he should have. Your medical book cautions individuals with normal health against giving blood too frequently, and I agree. However, this good advice doesn't apply to him because of his illness.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.