Erythrocytosis is a specific pathological condition of the body, which is characterized by an increase in the blood flow of the number of red blood cells and hemoglobin. The presence of erythrocytosis in humans can be said with increasing erythrocytes from 6 T / L and hemoglobin - from 170 g / l.
It is important to understand that erythrocytosis is an indicator of the pathological process. In its way, erythrocytosis is a kind of "mirror of pathology," because most often it appears as an adaptive function of the body for certain pathophysiological processes. In addition, erythrocytosis may become a manifestation of tumor processes or chronic hypoxia and may be their only manifestation. Therefore, you need to know all the manifestations of this state and the reasons that it can cause. This is necessary for its timely detection and treatment, which must be done before the body has suffered irreversible damage.
The causes of erythrocytosis are different.
Isolate physiological erythrocytosis, the emergence of which is due to physiological changes in the body. It refers to erythrocytosis in the inhabitants of high mountains. The fact is that in such areas the oxygen content in the air is reduced, it gets into the body in less quantity than it needs. Automatically the body produces a greater number of red blood cells than normal. Physiological erythrocytosis develops. In this way, he tries to "grasp" as much oxygen as possible by the erythrocytes: the process of hypoxia triggers the release of erythropoietin by the kidneys and activates the formation of red blood cells in the bone marrow.
It is important to note that this process is not instantaneous, but develops gradually, as an adaptive function of the body to hypoxia. Therefore, it is necessary to look for erythrocytosis in those who have lived a sufficiently large amount of time in the conditions of rarefied air.
Also, physiological erythrocytosis is observed in newborns. Since the child was receiving in the womb maternal blood, in which the percentage of oxygen was much less than its percentage in the air. Therefore, at birth, the child has a higher number of red blood cells than in a similar analysis, for example, 2-3 days after birth.
In addition to the physiological distinguish two more types: absolute erythrocytosis and relative.
Absolute erythrocytosis occurs due to the enhancement of the erythropoietic function of the bone marrow. It can be stimulated by chronic lung diseases (such as COPD, emphysema, blue congenital heart defects: tetralogy of Fallot ).
Relative erythrocytosis is an increase in the number of erythrocytes and hemoglobin per unit volume of blood, due to a lack of plasma volume. A vivid example of relative erythrocytosis is blood loss, a decrease in the volume of circulating fluid during vomiting, and massive diarrhea.
Isolate primary and secondary erythrocytosis
The causes of primary erythrocytosis consist in genetic defects, due to which erythrocytes more heavily give oxygen to tissues. Genetic defects appear in the globin, the constituent part of the hemoglobin molecule, or the content in the erythrocytes of a special regulator that is responsible for its oxygenation and deoxygenation ("loading" and "unloading" of oxygen in the red blood cells) is disrupted. As a result, this increases the affinity of hemoglobin for oxygen and deteriorates its return to tissues. Develops a hemic hypoxia of the body, which stimulates the release of erythropoietin by the kidneys, which stimulates erythropoiesis in the red bone marrow.
Secondary (symptomatic erythrocytosis) include such erythrocytosis, which arose as a consequence of other diseases.
Secondary erythrocytosis is also subdivided into relative and absolute. The secondary absolute erythrocytosis includes states due to which, as a result of more active erythropoiesis or passage to the vascular bed from the bone marrow, the number of erythrocytes per unit volume of blood increases.
The cause of secondary absolute erythrocytosis can serve as different states. For example, diseases accompanied by ischemia or tumor kidney damage, resulting in a large release of erythropoietin, which will stimulate the creation of new red blood cells in the red bone marrow.
Kidney cysts, various inflammations, stenoses of the renal arteries, hydronephrosis can lead to situations accompanied by kidney ischemia. To neoplastic kidney lesions that lead to increased production of red blood cells, hypernephroma of the kidney, nephroblastoma , and tumor secreting erythropoietin can be classified. In addition, an increased number of red blood cells can cause kidney transplantation, blood transfusion of athletes.
Also, various disorders of neurohumoral regulation, in which the sympathetic nervous system will be excited, can lead to erythrocytosis.
In addition, increased production of erythropoietin can lead to increased production of hormones. This is due to the fact that thyroid hormones, adrenocorticotropic hormones, catecholamines and glucocorticoids increase the utilization of oxygen by the body. And the further scheme of the body's reaction to a decrease in oxygen in it is quite predictable: in response to hypoxia, erythropoietin will enter the bloodstream, and the number of red blood cells will also increase. This also includes taking androgenic steroids as doping, to increase muscle mass.
An important example in absolute secondary erythrocytosis are those that appeared as a result of tumor diseases of the red germ of hematopoiesis in the bone marrow. A vivid example of these diseases is true erythremia or Vaquez disease. It is characterized by a significant erythropoiesis: the number of erythrocytes in the blood of such patients can increase 7-10 times from the norm.
One of the brightest reasons, of course, is the effect of hypoxia and lung diseases on the onset of symptomatic erythrocytosis. Distinguish hemic, respiratory, circulatory and tissue hypoxia.
With hemic hypoxia, erythrocytosis will develop as a result of a decrease in oxygen capacity in the blood. As an example, poisoning with carbon monoxide, nitro compounds is suitable here.
Circulatory hypoxia induces erythropoiesis due to insufficient pumping function of the heart and insufficient blood supply to tissues and organs. A vivid example of this type of hypoxia is heart failure .
Respiratory hypoxia is a consequence of various diseases of the pulmonary system, as a result of which the volume of ventilation of the alveoli decreases. Examples are: bronchial asthma , chronic bronchitis , various chronic lung diseases.
Tissue hypoxia will result from a decrease in biological oxidation. It can occur as a result of the progression of any of the above-described hypoxia.
Erythrocytosis secondary genesis can manifest themselves in exogenous hypoxia hypobaric and normobaric type. With normobaric hypoxia, the body does not receive oxygen with air, under normal barometric pressure in the environment. As an example, you can cite cases where a person for a long time is in a small space with a bad current of air (cabinet, elevator, mine). In the hypobaric type, an increase in the number of erythrocytes is obtained due to a decrease in the barometric pressure itself. A good example is decompression sickness.
The relative erythrocytosis of secondary genesis includes hemoconcentration forms and redistribution. Hemoconcentration erythrocytosis arises from the loss of water from the vascular bed. Example: strong sweat secretion in working conditions at high temperatures, prolonged thirst, vomiting and diarrhea in infectious diseases, consequences of burns, ketoacidotic coma in diabetic patients, ulcerative skin lesions.
Redistribution forms are formed when, under various stressful situations, red blood cells are sharply thrown into the circulating blood, which were previously found in the depositing organs and tissues.
One of the most interesting causes of symptomatic erythrocytosis is the Gaisbek syndrome (Gaysbek's disease). It is characterized by a combination of erythrocytosis with arterial hypertension . The reasons for its occurrence are unknown. There are theories about the hereditary predisposition to the disease.
Symptoms of erythrocytosis mainly depend on its type and are quite different. So, for example, skin coloring in patients with absolute increases in red blood cells will be plethoric - red. In relative forms, skin color is usually not changed. Also, in both forms, an objective increase in the spleen is not observed.
With cyanotic variants of erythrocytosis, the patients in the clinical picture will be dominated by cyanosis of the skin, which will increase in the supine position. All erythrocytosis associated with kidney damage is likely to be combined with high arterial hypertension.
With hereditary reasons for the increase in the number of red blood cells, erythrocyanotic skin color will be observed-red with the presence of cyanosis (since the organism tolerates hypoxia and contains a large number of erythrocytes in the bloodstream). This variant will also be manifested in patients from childhood.
In Vaquez disease, the patient will have characteristic symptoms: a bright red color of the face and skin; skin itching after bath procedures and pathological enlargement of the spleen.
It is important to know that with the acquired forms the number of erythrocytes is increased, as a consequence of compensatory reactions of the organism. Therefore, most often in the normalization of the factor that caused the disease, the secondary erythrocytosis disappears.
There are also headaches , neurological symptoms with cerebral causes. There may be fatigue, drowsiness, weakness as a response to increased blood viscosity and tissue hypoxia. There is a risk of thrombosis.
To determine this or that form of the disease, it is necessary to conduct some laboratory studies:
- Study of a general blood test: the level of red blood cells in men and women
- Definitions of serum levels of erythropoietin
- Investigation of the gas composition of blood
- Ultrasound examination of the kidneys
- Intravenous pyelography
- Measurement of hematocrit and hemoglobin levels
- Ultrasound examination of the heart and blood vessels
- Determination of the level of reticulocytes (young precursors of erythrocytes) in the blood
- Determination of the number of platelets and white blood cells (for differentiation with Vaquez disease)
Treatment of erythrocytosis is based on the treatment of the etiological factor that caused it. Patients with hypoxic forms are treated with oxygen. With erythremia, bloodletting is prescribed with appropriate laboratory parameters (the hematocrit should be at least 50%). After the procedure, various blood replacement solutions are administered to patients for prevention.
Similar treatment is also prescribed for patients with relative erythrocytosis, where all attention is drawn to the restoration of lost volumes of plasma. In addition, a correction of the condition that caused this kind of erythrocytosis is necessary. For example, an infectious disease should be prescribed therapy directed against the pathogen. If there are manifestations of ketoacidotic coma, change the dose of insulin, prescribe the administration of isotonic infusions. If the cause of erythrocytosis is high temperature, then it is necessary to carry out "lytic" therapy to reduce it.
Surgical treatment with erythrocytosis can be prescribed in case of corresponding deterioration of the underlying disease or in its oncological nature.
Also, patients follow a certain diet: it excludes fatty and iron-containing foods.
In addition, it is important to observe the correct mode of life: smoking patients with erythrocytosis should abandon this habit, and those patients who suffer from increased body weight, you must gradually reduce your weight.