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Overview
What is Polycythaemia?
- Polycythaemia (also spelled polycythemia) is a condition where you have too many red blood cells in your blood.
- This makes your blood thicker, which can increase the risk of blood clots and other problems.
Who is Affected?
- Polycythaemia can affect anyone but is more common in adults.
- There are two main types:
- Primary polycythaemia (Polycythaemia Vera, PV): caused by a problem in the bone marrow.
- Secondary polycythaemia: caused by factors outside the bone marrow, such as low oxygen levels.
Causes and Risk Factors
Why Does It Happen?
- Primary polycythaemia (PV):
- Usually caused by a change (mutation) in the JAK2 gene, making the bone marrow produce too many red cells.
- Secondary polycythaemia:
- The body makes more red blood cells in response to low oxygen, which can be due to:
- Living at high altitudes
- Chronic lung or heart disease (such as COPD)
- Smoking
- Some tumours (rare)
- Use of certain medicines (like erythropoietin)
- The body makes more red blood cells in response to low oxygen, which can be due to:
Are Certain People More at Risk?
- Smokers
- People with long-term lung or heart problems
- People with sleep apnoea
- Those living at high altitudes
- People with a family history of PV
Symptoms
What are the Common Signs and Symptoms?
- Many people have no symptoms at first.
- Possible symptoms include:
- Headaches
- Dizziness or vertigo
- Itchy skin (especially after a hot shower)
- Red or flushed face
- Tiredness (fatigue)
- Blurred vision
- Night sweats
- High blood pressure
- Pain, redness, or swelling in the hands and feet
- Easy bruising or bleeding
- Gout (joint pain)
Diagnosis
How is it Diagnosed?
- Diagnosis starts with a blood test showing a high red blood cell count (high haemoglobin or haematocrit).
- Your doctor may check for:
- JAK2 gene mutation (for PV)
- Oxygen levels in your blood
- Erythropoietin (EPO) levels
- Bone marrow biopsy (in some cases)
- Other tests may include:
- Chest X-ray or ultrasound (to look for tumours)
- Sleep study (for sleep apnoea)
Treatment Options
What are the Treatment Choices?
- Treatment depends on the type and cause.
- Primary Polycythaemia (PV):
- Venesection (phlebotomy): Regularly removing blood to reduce red cell levels.
- Medications:
- Low-dose aspirin to reduce clot risk
- Drugs to slow blood cell production (e.g., hydroxyurea, interferon)
- JAK inhibitors (for some patients)
- Control of risk factors (e.g., blood pressure, cholesterol)
- Secondary Polycythaemia:
- Treat the underlying cause (e.g., improving oxygen levels, treating lung or heart disease)
- Venesection may be used if symptoms are severe
Are There Any Advanced or Investigational Therapies?
- Newer medications such as JAK inhibitors are available for some cases of PV.
- Participation in clinical trials may be an option for some patients.
Dietary Advice
Specific Dietary Recommendations
- Stay well-hydrated: Drinking enough fluids can help keep blood from becoming too thick.
- Healthy, balanced diet: Emphasise fruits, vegetables, whole grains, lean proteins, and healthy fats.
- Limit iron supplements: Unless prescribed, as extra iron may boost red cell production further in PV.
- Moderate alcohol: Excess can dehydrate or increase clot risk.
- Maintain a healthy weight: Helps lower risk of blood clots.
Nutrition Tips to Support Treatment or Symptom Control
- Eat foods that help control blood pressure and cholesterol (e.g., less salt, more fibre).
- Include foods rich in antioxidants (berries, leafy greens).
- Discuss any vitamin or mineral supplements with your doctor.
Common Supplements and When to Discuss with Your Doctor
- Avoid iron supplements unless recommended by your doctor.
- Multivitamins are generally safe, but check with your doctor first.
Food Safety or Drug-Food Interactions
- Be careful with foods or drinks that can affect medications (ask your doctor about specific interactions).
- Limit grapefruit juice if on certain medications.
Living with the Condition
Managing Daily Activities
- Avoid activities that could cause injury or bleeding, especially if you are on blood thinners.
- Take precautions in hot weather to prevent dehydration.
Exercise, Lifestyle, and Emotional Well-being
- Regular moderate exercise (e.g., walking, swimming) improves circulation.
- Avoid smoking and manage stress.
- Seek support groups or counselling if you feel anxious or overwhelmed.
Tips for Long-term Monitoring and Follow-up
- Regular check-ups and blood tests are important.
- Monitor for new symptoms, especially signs of clots (pain, swelling, chest pain, shortness of breath).
- Adhere to treatment and medication plans.
FAQs
1. Is polycythaemia a type of cancer?
- Primary polycythaemia (PV) is considered a slow-growing blood cancer, but many people live normal lives with regular treatment.
2. Will I need treatment forever?
- Most patients need lifelong monitoring and sometimes ongoing treatment, especially with PV.
3. Can polycythaemia be cured?
- PV cannot usually be cured but can be managed well. Secondary polycythaemia may resolve if the underlying cause is treated.
4. What should I do if I get a sudden headache or chest pain?
- Contact your doctor or go to the emergency department, as this could be a sign of a blood clot.
5. Can I travel if I have polycythaemia?
- Yes, but discuss with your doctor first. Take precautions to avoid dehydration and move regularly during long trips to prevent clots.
Call to Action: When to Contact a Doctor
- If you develop new or worsening symptoms (severe headache, vision changes, chest pain, sudden weakness, or trouble breathing).
- If you notice unusual bleeding, bruising, or pain/swelling in your limbs.
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