Polycythemia – too many red blood cells in the blood


Polycythemia means that you have too many red blood cells in your blood. It makes the blood flow thick. Polycythemia can be a disease but it can also be a consequence of other diseases. The treatment you receive depends on what form of polycythemia you have.

There are two different forms of polycythemia:

  • Primary polycythemia called polycythemia vera.
  • Secondary polycythemia. 

Symptoms of polycythemia

It is common to feel no symptoms of polycythemia at all in polycythemia vera. Here are some symptoms you may feel:

  • Headache and dizziness.
  • Fatigue and feeling of weight in the head.
  • Itching after showering or bathing hot.
  • Stomach filling in the stomach.
  • Skin redness and pain in the skin of the lower legs or feet and hands.
  • Swollen legs or other symptoms of blood clots.

Symptoms of secondary polycythemia

The symptoms of secondary polycythemia are partly the same as in polycythemia vera. The symptoms depend on how thick the blood is and whether there is another disease that has caused an increased amount of red blood cells.

Common symptoms secondary polycythemia:

  • Tiredness.
  • Headache.

When and where should I seek care?

If you have repeated symptoms of any of the symptoms described above, contact a health care provider. You can contact many receptions by logging in.


Most symptoms of polycythemia can be due to several different diseases. Therefore, the doctor begins to suspect that you have polycythemia if your blood value is high. If your doctor suspects you have polycythemia, more blood tests will be taken to see if the amount of red blood cells is elevated. A genetic blood test is also taken because almost everyone who has polycythemia vera has a special change, a mutation, in a gene that controls how blood is formed. 

What happens in the body?

Polycythemia vera

Polycythemia vera is a blood disorder. It means that the bone marrow produces too much red blood cells.

There is usually a balance between stimulating factors and factors that slow down blood formation. They make the production of red blood cells at a reasonable level. In polycythemia vera, there is a change in the gene that maintains that balance. The change causes too many red blood cells to form.

This results in high hemoglobin in the blood and a high value on a sample showing the distribution between red blood cells and blood plasma. That sample is called hematocrit value. Blood plasma is the fluid that surrounds the blood cells.

The blood becomes thick if you have an elevated hematocrit value. This increases the risk of blood clots. In many cases, polycythemia vera is detected after a blood clot. It can be a blood clot in the bone, in the heart or in the brain or in more unusual cases a blood clot in the stomach.

Polycythemia vera is a chronic, lifelong disease that is considered a cancer disease. After a few years, you may have other symptoms, such as enlargement of the spleen.

Secondary polycythemia

Secondary polycythemia is called when the body experiences an increased need for red blood cells and therefore produces more, or when there is an overproduction of the hormone EPO. It is a hormone that is formed in the kidneys and controls the formation of red blood cells.

Secondary polycythemia can occur if the body has received too little oxygen for an extended period of time. It may be due to a disease that affects breathing such as chronic obstructive pulmonary disease, COPD, or some heart disease.

Secondary polycythemia can also occur if you have a certain type of cancer tumor that produces too much of the hormone EPO. This can happen in, for example,  kidney cancer.

Apparent polycythemia

There is a third form of polycythemia called apparent polycythemia. It is not a disease in itself but means that the blood contains too little blood plasma in relation to the number of red blood cells. It may be due to stress or dehydration. It may also be because you are being treated with liquid drugs. Apparent polycythemia does not need to be treated, but you are being treated for what has caused the reduction in the amount of blood plasma.

Treatment of polycythemia

Treatment of polycythemia vera

The treatment of polycythemia is to reduce the symptoms and to reduce the risk of blood clots. This is done by reducing the number of red blood cells in the blood by means of blood draws or by slowing the blood formation with drugs.

In order to quickly reduce the blood level to a normal level, initially, the blood is taken more than once a week. Thereafter, the bottling takes place at regular intervals, usually every four to six weeks. It depends on the size of the red blood cell overproduction.

You who have polycythemia vera should also be treated with salicylic acid tablets to prevent blood clots. This is because there is an increased risk of blood clots even after you have been treated with drops.

You who have polycythemia vera and who have had a blood clot or are over 60 have a greater risk of blood clots. Then you need treatment with drugs that slow the bone marrow’s production of red blood cells.

You who have polycythemia vera receive treatment and follow-up for the rest of your life. The treatment you receive does not cure the disease but allows you to live pretty much normally.

Treatment of secondary polycythemia

Secondary polycythemia does not present the same risk of blood clots as polycythemia vera. The treatment is primarily aimed at the root cause, which is another disease. If your blood levels and symptoms are greatly elevated, you may be treated with regular blood draws. 

Influence and participate in your care

You can seek care at any medical center or open specialist clinic you want throughout the country. Sometimes a referral  to the open specialized care is required.

You should understand the information

In order for you to be involved in your care and treatment, it is important that you understand the information you receive from the healthcare staff. Ask questions if you don’t understand. For example, you should receive information about treatment options and how long you may have to wait for care and treatment.

Children should also be involved in their care. The older the child, the more important it is.

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