High Hemoglobin, Hematocrit, Mcv, Mch

[juliegee]

Help me to understand this. I know we've "chatted" about it before, but I'm trying to understand the mechanism behind it. My son's blood work just came back with abnormally high hemoglobin, hematocrit, MCV, MCH. This is NOT new for him. My blood work is very similar. His doc at Hopkins says this is typical for CFS patients. Because high MCV, MCH are indicative of a B-12 and folic acid deficiency, Dr. Rowe always recommends that we check for that too. It's always normal for him (me too.) This time Dr. Rowe still wants him to begin supplementing- despite a normal result. he says the B-12 may work on a different mechanism (perhaps as an antioxidant?) to provide relief from fatigue. My MCAD doctor also recommended this. I complied, but experienced no relief.

Any me too's with the weird blood work? Any ideas as to the mechanism behind it? Any relief with supplementing B-12 and folic acid?

Thanks-

Julie

[issie]

I just read an article about B12 somewhere. It said that allot of people don't take up the oral form of it properly and that it has to be given in a shot form for them to metabolize it. It is supposed to help with energy and aniema. Folic acid is now beginning to be understood to help with depression that doesn't respond to RX's. Also, B6 is helping allot with muscle disorders. If you take a B vitamin, you must take a complex in addition to the specified B that is recommended or you will create an imbalance.

[sue1234]

I know a high hematocrit can mean dehydration. Boy, does that ever ring a bell!!!! But, the other possibility is polycythemia. About 15 years ago my ob/gyn told me I had a high hematocrit and I would just have to donate blood every so often to keep it at an acceptable level. I never did donate, but I look back and realize I didn't drink near enough fluids. I then started with heavy, perimenopausal periods, so that high hct went away quickly!

[firewatcher]

Count me in the high RBC, hematocrit and hemoglobin crowd. Mine has been high for several years now. The only time mine tested normal was when I was technically overhydrated from dDAVP (then my electrolytes were wonky!) I took B-everything when I had Mono several years back and then at my big POTS crash, but it never helped with fatigue. I finally got my bloodwork results from that time period and my b12 levels were 5 times higher than normal....I don't think I used any of it, it just built up in my system.

[juliegee]

Yeah, we know about the dehydration aspect. Mack drank 4 16 oz bottles of water before his blood work. He always drinks a lot before blood is taken as they have a hard time getting any unless he is really well hydrated AND he tends to faint during the draw & boosting his blood volume before hand helps...so it's not simple dehydration, more like chronic low blood volume.

Polycythemia's a thought, but his numbers are not quite high enough AND he has the high MCV and MCH. The whole picture is indicative of dehydration and altitude sickness, except he's hydrated and we're practically at sea level. I know a lot of folks here (myself included) have the same results. WHY?

[juliegee]

Count me in the high RBC, hematocrit and hemoglobin crowd. Mine has been high for several years now. The only time mine tested normal was when I was technically overhydrated from dDAVP (then my electrolytes were wonky!) I took B-everything when I had Mono several years back and then at my big POTS crash, but it never helped with fatigue. I finally got my bloodwork results from that time period and my b12 levels were 5 times higher than normal....I don't think I used any of it, it just built up in my system.

Yeah, that's kind of my reaction to B-12 too. My levels actually looked high, but I didn't feel any more energetic. I guess I'll try it on Mack since his doctor (who we adore!) recommends it. You never know......

[Birdlady]

It's better to test urine methylmalonic acid for B12 deficiency especially if you've been supplementing with it. I take daily injections of B12 yet my MMA is still always high. My body can't get enough of it! lol I don't even bother checking my B12 levels because it's not reliable at all for me.

[TXPOTS]

Mack's Mom,

I've had the high hemoglobin, HCT, and borderline high MCV for as far back as I remember. It's possible that this coincided with the polyuria that I first developed at age 16. I was worked up for polycythemia years ago, and this was ruled out. My POTS specialist told me this is a finding that he sees a lot. He calls it hemoconcentration from dehydration. This is NOT funny anymore, but I used to joke with my husband that I must have diabetes insipidus and that my hemoglobin was higher than his, and he was the big red meat eater. Now I believe these were little warning signs of what was to come. My vitamin B12 is at the high end of normal as well. I am awaiting methylmalonic acid results. Thanks for your reply to my CO2 post.

[Birdlady]

I probably should have added that I've had high HBG and HCT before too, but I don't really check my CBC very often to know what's been happening recently.

[juliegee]

Thanks, everyone, for your input. Texas' idea of super concentrated blood due to dehydration sounds plausible. Does that mean that our blood is actually thick? Are we more prone to clotting? Should we be using aspirin, blood thinners?

I was hospitalized once when my finger went cyanotic and stayed that way. I overheard a team of doctors, treating me, talking about the "thickest" blood they'd ever seen. I was put on some IV blood thinner for a few days & had oodles of tests. In retrospect, it was probably the IV that helped me the most .

[Birdlady]

My guess is dehydration too, but other indicators for dehydration were not found in my electrolytes those mornings. Usually sodium should come up a bit (143 ish)and your BUN/Creat ratio would be on the high end of normal like >18.

My doctor just said it's hemoconcentration and to not worry about, which I disagreed with since I had been on DDAVP when this started to show up! How can you be dehydrated on DDAVP?

[issie]

I know a high hematocrit can mean dehydration. Boy, does that ever ring a bell!!!! But, the other possibility is polycythemia. About 15 years ago my ob/gyn told me I had a high hematocrit and I would just have to donate blood every so often to keep it at an acceptable level. I never did donate, but I look back and realize I didn't drink near enough fluids. I then started with heavy, perimenopausal periods, so that high hct went away quickly!

Were your iron levels too high too? Allot of the time when you're told that you need to donate blood or have blood drawn it's because of hemochromatosis. Too much iron in your blood. I don't know if it causes the hematocrit to be too high. Haven't researched this in a long time. I do have a friend who has hemochromatosis and he can't eat red meat or cook in iron cookware, etc. He also has to have blood drawn every month or two to keep his iron levels down. I was just wondering if there is a connection?

[comfortzone]

MCV and MCH elevations are sometimes early signs of liver damage from alcoholism as well I learned when I was a nurse.... Not that that's the case or has anything to do with your case etc...but I toss it out there. I don't drink but rarely but my brother and I have had those numbers high or borderline high for a long time. Our hb and hct though are high in the normal range......we have no idea why ours our high for a lifetime tho.

[vemee]

This is my theory and has no medical backing so take it with a grain of salt. People who live at high altitudes have higher than normal hematocrit, this is to compensate for there being less oxygen available. The body produces more red blood cells to carry more oxygen instead of producing more blood. Some people with pots that have blood pooling also have perfusion problems because of the drop in circulating blood volume when vertical. The body reacts by producing more red blood cells to make up for what is lost to pooling. I also think that those with low ferritin levels might be in this group. The body uses iron to make red blood cells, ferritin is used to store iron in the cells until it is needed by the body to replace the circulating iron.

Again this is just my opinion but if you think it sounds good you might ask your doctor.

[TXPOTS]

My sodium has never been high, so it was a challenge getting a proper diagnosis of hypovolemia, diabetes insipidus, and hypoaldosteronism. Later, it was discovered my renin and aldosterone (responsible for sodium retention) were low and unmeasurable. So, despite the normal sodium, I was indeed dehydrated. I think this may relate to the renin/ aldosterone paradox that Vanderbilt and Dr. Stewart have noted in some POTS patients. At one point, it was awful: no skin turgor, tears, dry mucous membranes, severe weight loss, and these awful veins that would not give blood during draws, but my sodium was always normal. I look and feel much better on the Florinef and DDAVP, though I am not free of POTS. I imagine even POTS patients who do not have absolute hypovolemia still have thoracic hypovolemia and cerebral hypoperfusion when upright. I wonder how this plays into the high hemoglobin and HCT. We appear to be hypoxic individuals because the blood flow is not getting to where it needs to be at the right times. Good question about the thick blood. I also wonder the same.

[juliegee]

So super-concentrated blood results from our hypovolemia & our body's attempt to compensate for the subsequent hypoxia....If that's not enough oxygen, let's make the RBC's bigger- (high MCV) and let's make more of them (high MCH). I think the researchers can learn from us Thank you for your collective wisdom!

I still am curious about "thick" blood. Is that something we need to worry about? Do we need blood thinners more than healthy people to prevent heart attacks/strokes/clots because of our super-concentrated blood?

[firewatcher]

So super-concentrated blood results from our hypovolemia & our body's attempt to compensate for the subsequent hypoxia....If that's not enough oxygen, let's make the RBC's bigger- (high MCV) and let's make more of them (high MCH). I think the researchers can learn from us Thank you for your collective wisdom!

I still am curious about "thick" blood. Is that something we need to worry about? Do we need blood thinners more than healthy people to prevent heart attacks/strokes/clots because of our super-concentrated blood?

Julie, How thick is it? What is your serum Osmolality measuring? That is blood thickness. Mine is always high. It can have some side effects both long and short term, depending on how high your Osm is. Too high will cause seizures and coma, long term but slight elevations can possibly cause organ damage or blood clots.

[TXPOTS]

If you have serum osmo taken make sure the lab uses a direct measurement machine. Some lab/ physicians do not have the technology and run the calculations by hand, which is not as accurate.

[Dizzysillyak]

Hi ... I don't know what my MVC, MCH or other levels are right now but since it relates to B12, I thought you might be interested in this ...

I didn't see any mention of the active forms of B12 in here ... I started an active B12 protocal based on a thread I found at Pheonix Rising and it might be helping me. It's hard for me to tell because I started a few other things at the same time because my labs came back saying that I was low on pregnenolone, DHEA and testosterone ...

My doc approved me starting all of this at once since I was supposed to be on the other forms of B12 and folate already. Shots never really worked for me unless I hadn't had one in about a month. Later, I tried Metagenics Vessel Care but even 1/2 of one made me hyper,gave me insomnia and caused UTI symptoms.

Here's my thread on this protocal at gluten free and beyond though. I give the links to Fred's (author of the active B12 protocal) in my thread ... HTH ...

http://glutenfreeandbeyond.org/forum/viewt...&highlight=

BTW. I was never tested for DI but my frequent urination and my leaking are gone now. I "think" all that urinating was my body's way of clearing toxins out of my system. AZO with probiotics keeps this under control. I was taking 4 a day but now I only need two every couple of days ... B complexes always made me urinate more frequently if that helps ...

[sue1234]

Mack's Mom--yeah, when I said dehydration, I know it sounds like the "simple" or "normal" answer. But, I was just pointing out that in NORMAL people, this is what a high HCT could mean. Now, knowing there is nothing normal about all of us, it still could point to dehydration. But, then we have to ask WHY? We know we hydrate more than normal people because we know we need to with POTS. So, why, when we overhydrate, do we still have "dehydrated"-looking lab parameters? It would be interesting to have your son NOT drink four bottles of water before labs to see what his "true" numbers are--but then again, maybe all that he drinks does not alter his labs if it literally is going right through him.

I never have a high HCT anymore. However, I have alot of other signs of dehydration like TXPOTS mentions--the bad skin turgor(tenting), dry everything!

When in the hospital for my 3 day fast, they gave me injections for an anticoagulant. I have no idea why!! And then in the last couple of months during blood draws, the techs ask me if I am on any kind of blood thinners. I have no clue why. I should have asked if my blood seems too thick or thin. Sometimes I just don't THINK in a timely manner.

Issie--not long after I had a high HCT, I found out I had low ferretin. I never had a high hemoglobin.

I agree that if alot of us are having odd labs, that low blood volume has got to be at the basis of this aspect. I can't imagine why, except for problems with the pituitary and its anti-diuretic hormone, or the adrenal gland's aldosterone hormone. I have been found to have both at low levels, but nobody has quite addressed them. I know a few of us have one or the other(or both) low levels. So WHY? Let's keep asking WHY and those that still have a brain(not me!) can keep picking this issue apart until we see commonalities.

[juliegee]

So super-concentrated blood results from our hypovolemia & our body's attempt to compensate for the subsequent hypoxia....If that's not enough oxygen, let's make the RBC's bigger- (high MCV) and let's make more of them (high MCH). I think the researchers can learn from us Thank you for your collective wisdom!

I still am curious about "thick" blood. Is that something we need to worry about? Do we need blood thinners more than healthy people to prevent heart attacks/strokes/clots because of our super-concentrated blood?

Julie, How thick is it? What is your serum Osmolality measuring? That is blood thickness. Mine is always high. It can have some side effects both long and short term, depending on how high your Osm is. Too high will cause seizures and coma, long term but slight elevations can possibly cause organ damage or blood clots.

I am always learning. I thought the high concentration of RBC's meant that the blood was thick....sounds like there's another value I should be checking. I don't have my labs from my cyanotic finger incident (few years ago), but I looked for serum osmolality on Mack's recent blood work & I don't see it. I guess it's not part of the basic metabolic panel, unless there's an acronym that I don't know about.

Seems like that would be an issue with us dehydrated POTsies.

[juliegee]

Mack's Mom--yeah, when I said dehydration, I know it sounds like the "simple" or "normal" answer. But, I was just pointing out that in NORMAL people, this is what a high HCT could mean. Now, knowing there is nothing normal about all of us, it still could point to dehydration. But, then we have to ask WHY? We know we hydrate more than normal people because we know we need to with POTS. So, why, when we overhydrate, do we still have "dehydrated"-looking lab parameters? It would be interesting to have your son NOT drink four bottles of water before labs to see what his "true" numbers are--but then again, maybe all that he drinks does not alter his labs if it literally is going right through him.

I never have a high HCT anymore. However, I have alot of other signs of dehydration like TXPOTS mentions--the bad skin turgor(tenting), dry everything!

When in the hospital for my 3 day fast, they gave me injections for an anticoagulant. I have no idea why!! And then in the last couple of months during blood draws, the techs ask me if I am on any kind of blood thinners. I have no clue why. I should have asked if my blood seems too thick or thin. Sometimes I just don't THINK in a timely manner.

Issie--not long after I had a high HCT, I found out I had low ferretin. I never had a high hemoglobin.

I agree that if alot of us are having odd labs, that low blood volume has got to be at the basis of this aspect. I can't imagine why, except for problems with the pituitary and its anti-diuretic hormone, or the adrenal gland's aldosterone hormone. I have been found to have both at low levels, but nobody has quite addressed them. I know a few of us have one or the other(or both) low levels. So WHY? Let's keep asking WHY and those that still have a brain(not me!) can keep picking this issue apart until we see commonalities.

Hi Sue-

Thanks for your help- interesting observations. It would be interesting to see Mack's blood work w/o the extra water before the draw, but Mack really MUST super-hydrate before blood draws. Unless he does, they literally CAN'T get any blood from him (it doesn't come out) AND he really does faint with low blood volume. I can't tell you how many times, I've had to catch him.

His local Dr's office doesn't have a place for him to lie down during a draw. Even though I warn them ahead of time, they still make him sit, I catch him when he slumps, then they get a wheel chair & throw him in an exam room until he stabilizes Grrrrrrrrr So silly when we KNOW that will happen and he's 6'2"!!!!! Cumbersome to say the least.

Interesting about your varying blood thickness. Me too! I've had the "thick blood" comment & subsequent treatment. BUT, the last time I had blood drawn (to check IgG), the tech said "WOW, you have pale blood." What does that mean? I guessed she meant thin. In addition to an 81mg aspirin, I drink iced green tea all day (to counteract my "thick" blood.) Green tea is a potent blood thinner and must be stopped several days prior to surgery. I attributed my "thin" blood to that. Perhaps the serum osmolality is something we should be checking....

Julie

[firewatcher]

Normal serum Osmolality is 285-295 mOsm/kg

You can calculate it with your normal labs using this formula:

Serum Osmolality (United States) = (2 x serum sodium) + (BUN / 2.8) + (serum glucose / 18)

SI units ares all molar, so no need to divide by 2.8 or 18 or 4.6.

Like TXPots said, this is a rough calculation and for me is incredibly inaccurate. When it is actually measured, mine is always higher than calculated. I have mine measured every 6 months to make sure that my dDAVP is not causing hemodilution. Mine is usually 293 on dDAVP, but has been as high as 304 after an overnight fast. Panic values for serum osmolality are values of less than 240 mOsm or greater than 321 mOsm. A serum of osmolality of 384 mOsm produces stupor. If the serum osmolality rises over 400 mOsm, the patient may have grand mal seizures. Values greater than 420 mOsm are fatal.

[juliegee]

Normal serum Osmolality is 285-295 mOsm/kg

You can calculate it with your normal labs using this formula:

Serum Osmolality (United States) = (2 x serum sodium) + (BUN / 2.8) + (serum glucose / 18)

SI units ares all molar, so no need to divide by 2.8 or 18 or 4.6.

Like TXPots said, this is a rough calculation and for me is incredibly inaccurate. When it is actually measured, mine is always higher than calculated. I have mine measured every 6 months to make sure that my dDAVP is not causing hemodilution. Mine is usually 293 on dDAVP, but has been as high as 304 after an overnight fast. Panic values for serum osmolality are values of less than 240 mOsm or greater than 321 mOsm. A serum of osmolality of 384 mOsm produces stupor. If the serum osmolality rises over 400 mOsm, the patient may have grand mal seizures. Values greater than 420 mOsm are fatal.

Thanks for that formula. Mack's is: 259- per your formula, at the lower end, but OK. How scary to have to worry about that while on dDAVP, but the consequences of NOT staying on top of it are dire. So despite his high red counts, Mack does NOT have thick blood.

I have my FIRST physical scheduled for next month I'll try to remember to check mine too.

THANKS!

Julie

[sue1234]

Okay, I just calculated mine and I got 302.5!! I am the one with the low ADH, so does that jive??

I actually have an appt. today with a GP. The appt. is to just become an established patient, as I only see specialists and never a GP because I am never sick with anything!! I just have POTS with a resultant abnormal life.

I planned on just telling him my POTS story, and mention some of my past abnormal labs, and them tell him if there is anything he can think of regarding my POTS to have at it. Should I now mention my "rough calculation" of the osmolality or ask if he can delve a little farther into my low ADH and "maybe run it along with an osmolality, because I read somewhere that they have to be interpreted together"??