Q: I recently did complete blood and my doctor said they were all within the normal range, but my red blood cells were much higher than the last time I had them a few years ago. I am a woman in my late 40s. He suggested I come back to rebuild them in six months. What do high red blood cells mean and how do I go about lowering them?
Dr. Grant replies: To properly interpret your question, I need some more details. Do you mean that your ‘red blood cells’ have a high hemoglobin (oxygen-carrying red blood cell) count? Or is there simply a high RBC (red blood cell) count but hemoglobin is within the range of normal? Secondly, what are other measures of red blood cells (MCV, HCT, MCH, MCHC) and what are your iron stores such as ferritin, serum iron, transferrin saturation? Third, are you having regular periods or do you have an IUD (intra-uterine device) for contraceptive reasons? Women who do not menstruate regularly may notice that their iron stores have become higher in routine blood tests than before. Are you taking any iron supplements or multivitamins with low-dose iron? How much red meat do you eat on a weekly basis, and remember that chicken and fish still contain about 70 pcs of iron versus red meat. Finally, is there a history of iron overload (hemochromatosis) in your family?
Ireland has one of the highest rates of a genetic condition in the world called hereditary hemochromatosis (HH). Iron overload due to HH occurs when the body absorbs excess iron from food and stores it in other tissues. When iron accumulates in the pancreas, it can usually lead to liver strain (liver failure even if not caught in time) and diabetes. Historically, this type of diabetes was known as bronze diabetes because of the tanning or bronze appearance of the skin. However, when iron accumulates in other tissues such as the heart, bones, and joints, it can cause heart failure, joint pain, fatigue, depression, and decreased libido. These signs and symptoms often become apparent after the age of 40.
The good news is that diagnosis is relatively simple. When two measures of iron stores in the blood are elevated, namely ferritin and transferrin saturation, then blood samples are sent for genetic testing. Treatment is only venesection (drawing a pint of blood) twice per year. When iron stores return to normal limits, blood can be donated to the Irish Blood Transfusion Board. Furthermore, there is no difference in mortality in patients with HH compared to the general population, once diagnosis is made in time and good compliance with treatment is maintained.
A certain level of caution should always be taken when interpreting routine blood tests in a healthy person without any signs or symptoms. The golden rule is to always repeat blood tests as things often return to normal. Unless the high ‘red blood cells’ are persistently high after repeated blood tests or worsening, there is usually no cause for concern. On a practical level, you might consider reducing (or omitting) red meat (if applicable), reducing chicken/fish portion sizes and aiming to drink two liters of water per day as These are seen as health-promoting behaviours.
Dr. Jennifer Grant is a GP with Beacon HealthCheck
