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Dr. Sunil Gandhi, Cancer & Blood Disease, 01/29/13

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Everything in excess is poison

By Dr. Sunil Gandhi

Recently, I saw a 70-year-old white male patient. He went to see his primary care physician for routine follow-up.

He had blood work that included a completed blood count (CBC). It showed he had too many red blood cells (RBCs) in his blood.
This condition is called polycythemia.

RBCs transport oxygen from the lungs to all over the body. So one may think that the more RBCs, the merrier. This will provide more oxygen to the body and that can only be good for the person.

I am sure you have heard that everything in excess is poison — or too much of a good thing can be bad, too. That is the case in this, too.

There are three kinds of blood cells: red blood cells (RBCs), white blood cells (WBCs or fighter cells), and platelets (clotters). WBCs are in the thousands, platelets are in the hundred-thousands and RBCs are in the millions in each millimeter of blood.

So, if RBCs increase in number significantly, it causes an effect similar to sludge in a pipe. It blocks the blood vessels, which are like a pipe transferring blood to various parts of the body. This can cause blockage, leading to an effect such as a stroke, heart attack or clot in the lung or leg, etc., depending on where the blood clots.

For diagnosis, I usually do a blood test called a JAK-2 gene test. This is positive in more than 95 percent of the patients with Polycythemia Rubra Vera. This is a condition where bone marrow makes too many RBCs. It was positive in my patient.

RBC count is measured by a component in CBCs called hemoglobin and hematocrit. These patients’ risk of clot is significantly less if hematocrit is kept below 45. This has shown to reduce the risk of stroke, heart attack, etc.

This can be done by periodic phlebotomy or by an oral drug called Hydroxyurea. Phlebotomy is done periodically by removing almost 500 milliliters of blood. It is recommended when hematocrit is above 45. The goal of treatment is to keep the patient’s hematocrit below 45. We should also aim to keep platelet count below 400,000 or so. Studies have shown that one aspirin (adult or baby) a day helps reduce the risk of clotting, too.

My patient is on Hydroxyurea and is tolerating it well without any undue side effects. This has cut down the necessity of doing phlebotomy significantly. He has not had any complication of polycythemia, either.

Dr. Sunil Gandhi is a hematologist and oncologist. He is volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.