High Red Blood Cell Count: Understanding, Causes & Treatments

Understanding the intricacies of our body’s functions can sometimes feel like deciphering a complex puzzle. One crucial element of this puzzle is our red blood cell count. Having a high red blood cell count can significantly impact your health, either indicating an underlying condition or leading to potential complications. In this comprehensive guide, we will delve into what a high red blood cell (RBC) count means, explore its causes, symptoms, diagnosis, and treatment options, and offer tips on managing and preventing this condition.

What is a High Red Blood Cell Count?

To grasp the concept of a high red blood cell count, it’s essential first to understand what red blood cells are and their function. Red blood cells are the most abundant type of cell in human blood and are primarily responsible for carrying oxygen from the lungs to the rest of the body and returning carbon dioxide back to the lungs for exhalation.

A high red blood cell count, medically known as erythrocytosis or polycythemia, occurs when the number of red blood cells exceeds the normal range. The normal range varies depending on age, sex, and altitude of residence, but generally, for men, it is about 4.7 to 6.1 million cells per microliter of blood, and for women, it is about 4.2 to 5.4 million cells per microliter.

Causes of High Red Blood Cell Count

There are several reasons why someone might have a high red blood cell count. These can be categorized into primary causes, which are directly related to issues in the bone marrow, and secondary causes, which are due to other conditions or external factors.

Primary Causes

Polycythemia Vera: This is a rare blood disorder in which the bone marrow produces too many red blood cells. It is a type of blood cancer and can lead to severe complications if not managed properly.

Genetic Mutations: Certain genetic mutations can result in increased production of red blood cells. These mutations often affect the way the bone marrow functions.

Secondary Causes

Chronic Hypoxia: Conditions that result in low oxygen levels in the body, such as chronic obstructive pulmonary disease (COPD), sleep apnea, and heart disease, can cause the body to produce more red blood cells to compensate for the lack of oxygen.

Erythropoietin: This hormone, produced mainly by the kidneys, stimulates the bone marrow to produce red blood cells. Certain tumors and kidney diseases can cause an overproduction of erythropoietin, leading to an elevated red blood cell count.

Dehydration: When the body loses water, the concentration of red blood cells can appear higher. This is not a true increase in red blood cells but rather a relative increase due to a decrease in plasma volume.

Living at High Altitudes: People living at high altitudes may naturally have higher RBC counts due to the lower oxygen levels in the environment. The body compensates by producing more red blood cells to enhance oxygen transport.

Performance-Enhancing Drugs: Athletes sometimes use erythropoiesis-stimulating agents (ESAs) or anabolic steroids to increase their RBC count, enhancing their endurance and performance.

Symptoms of High Red Blood Cell Count

Having a high red blood cell count can manifest in various symptoms, many of which are related to the thickening of the blood and decreased oxygen transport efficiency. Common symptoms include:

  • Fatigue: Despite having more red blood cells, the oxygen delivery to tissues might be inefficient, leading to fatigue.
  • Headaches: Increased blood viscosity can lead to headaches and dizziness.
  • Blurred Vision: Thickened blood can affect vision, causing blurriness.
  • High Blood Pressure: An elevated red blood cell count can increase blood pressure, straining the heart.
  • Itching: Especially after a hot shower or bath, increased histamine release can cause itching.
  • Joint Pain: High red blood cell counts can lead to gout, causing joint pain.

Diagnosis of High Red Blood Cell Count

Diagnosing a high red blood cell count involves a combination of blood tests and a thorough medical history. The primary tests include:

  • Complete Blood Count (CBC): This test measures the levels of red blood cells, hemoglobin, and hematocrit.
  • Erythropoietin Level: This test measures the level of erythropoietin in the blood to help determine if the cause is related to an overproduction of this hormone.
  • Oxygen Levels and Arterial Blood Gases: These tests assess the oxygen levels in the blood, helping to identify conditions like chronic hypoxia.
  • Bone Marrow Biopsy: In cases where polycythemia vera is suspected, a bone marrow biopsy may be conducted to examine the production of blood cells.

Treatment Options for High Red Blood Cell Count

Treatment for a high red blood cell count depends on the underlying cause. The primary goals are to reduce the red blood cell count to a normal range and to manage any symptoms or complications.


Phlebotomy is a procedure where blood is drawn from the body to reduce the number of red blood cells. It is similar to donating blood and can be done regularly until the red blood cell count returns to normal.


Hydroxyurea: This medication is often used in patients with polycythemia vera. It helps reduce the production of red blood cells by the bone marrow.

Interferon-alpha: This drug stimulates the immune system to reduce red blood cell production and is used in some cases of polycythemia vera.

Blood Thinners: To reduce the risk of blood clots, which is higher in individuals with elevated red blood cell counts, blood thinners such as aspirin may be prescribed.

Addressing Underlying Causes

For secondary causes, treating the underlying condition is crucial. For instance:

  • Oxygen Therapy: For individuals with chronic hypoxia, oxygen therapy can help manage the condition and reduce the need for increased red blood cell production.
  • Medications for Heart and Lung Diseases: Managing conditions like COPD or heart failure can help normalize red blood cell counts.

Lifestyle and Dietary Changes

Making certain lifestyle and dietary changes can also help manage high red blood cell counts. These include:

  • Staying Hydrated: Ensuring adequate hydration can help maintain a proper balance of blood plasma and red blood cells.
  • Avoiding Smoking: Smoking can decrease oxygen levels in the blood, leading to an increased red blood cell count. Quitting smoking can help mitigate this effect.
  • Regular Exercise: Engaging in regular physical activity can improve overall cardiovascular health and help maintain normal blood counts.
  • Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health and blood function.

Potential Complications

Ignoring a high red blood cell count can lead to several complications, including:

  • Blood Clots: Increased red blood cell count can thicken the blood, making clots more likely. These clots can lead to strokes, heart attacks, or deep vein thrombosis.
  • Enlarged Spleen: An overworked spleen, which filters blood, can become enlarged and cause discomfort.
  • Gout: Elevated red blood cell turnover can increase uric acid levels, leading to gout.
  • Peptic Ulcers: There is a higher risk of peptic ulcers in individuals with polycythemia vera due to increased histamine release.

When to See a Doctor

It’s essential to seek medical attention if you experience symptoms indicative of a high RBC count, especially if you have risk factors like chronic lung or heart disease. Early diagnosis and treatment can prevent complications and improve quality of life.


A high red blood cell count can signal various underlying health issues, from bone marrow disorders to chronic diseases affecting oxygen levels. Understanding the causes, symptoms, and treatment options is crucial for managing this condition effectively. By addressing underlying causes, making lifestyle changes, and following appropriate medical treatments, individuals can maintain a healthy RBC count and reduce the risk of complications. If you suspect you have a high RBC count, consult with a healthcare professional to determine the best course of action.

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