Okay, let's look at the reason that
the red blood cells are elevated.
Now, I'm going to give you
a pretty long list here.
What's most important is
you listen for the concepts,
rather than just try to memorize
this list of things.
So we're talking about what are the
reasons, if you look at your patient's
lab work and the red blood
cells are elevated.
These are the things I'd like
you to think through.
Think through what you know about the
patient, what medications they're on,
what their history is, and what your
assessment has already shown you.
Now you compare it to the lab values.
We know we have a patient
with red blood cells,
so the things we would consider
would be like polycythemia vera.
That's because the bone
marrow is going crazy.
Poly means multiple, cythemia
means from the blood.
Now we know the bone marrow is
putting out extra red blood cells.
Extra red blood cells is an adaptation
to being in high altitude.
Have you ever gone up to the mountains
when you're not used to being in the mountains?
You -- find your -- self -- very
-- short -- of breath
just walking from your car
to the look out site.
That's because we're not used
to that type of high altitude.
There's not as much oxygen available
as there is down below.
So if your body is in high altitude
long enough, it compensates.
I mean, stop and think about that. That
is super cool what your body can do.
So if I'm in an area of high altitude,
there's less oxygen available, you've
got extra red blood cells.
If you're there long enough, your
body will start cranking them out.
That's a means of adaptation.
There's even some elite athletes that
will go and train at high altitudes
to beef up their red blood cells, and then
they'll come back down to a normal altitude.
So keep in mind, this isn't a
super quick process.
Remember, white blood cells
can multiply very, very quickly.
It takes longer for red blood
cells to adapt.
Now congenital heart disease is
another thing we may think through,
and you would be pretty aware that your
patient has congenital heart disease.
That should be in their history.
Pulmonary disease is another problem.
Pulmonary disease or even specifically, COPD.
If these are chronic diseases and your
patient has had them over a period of time,
their body will learn to respond by
making these extra red blood cells
so they can carry more oxygen around.
Now, dehydration and renal problems can
also cause an elevated red blood cell.
Let's look at low red blood cells or anemia.
Aplastic anemia can be a problem,
or chronic renal failure.
Now, here's the deal with
chronic renal failure.
Kidneys no longer can make
Erythropoietin is what stimulates your
bone marrow to put out red blood cells.
Now, this was the problem my father had.
He went through chronic renal failure,
and was always low on red blood cells.
So fairly regularly, every couple of weeks,
he would have to go into
an outpatient clinic.
They would do a CBC.
They would look at his red blood
cell level, and if it was too low,
which it always was,
he'd had to have erythropoietin administered.
That's an IV medication.
It's very, very expensive.
But it's what will help the patient develop
those red blood cells that they need
to carry oxygen,
because their kidneys that are
in renal failure chronically,
no longer can make enough erythropoietin.
That's why they have to be
given extra erythropoietin.
But remember, it's a very expensive drug.
Now if a patient has an iron deficiency,
they'll also be low in red blood cells.
It matters that you understand what
causes the patient's low red blood cells
because we treat them differently.
If a patient's in chronic renal failure and
we just try and give them iron,
that's not going to fix the problem.
If they're just iron deficient, we don't
need to give them erythropoietin.
So that's why it matters that
you dig down deeper
to find out what's the cause of the anemia.
Now, there's pernicious anemia. Wow,
who knows what happens from there, right?
Bone marrow damage. Anytime the
bone marrow is damaged --
that's the source of making red blood cells,
we're going to have a lower red cell count.
Of course, leukemia or lymphoma
is going to be problematic,
or if somebody has blood loss.
Now it can be acute, meaning
blood is exiting my body,
or it can be chronic -- small
amounts of blood.
You see this a lot with patients who
have GI bleeding somewhere.
They just have this oozing that
kind of goes on all the time,
but it's not large and graphic
amounts of blood.
So you're going to see different types
of anemia, whether it's an acute loss,
or if it's a chronic loss over
a period of time.
Now we got some deficiencies in nutrition:
low in iron, vitamin B12, or
will also show you anemia.
So again, that's back to
if we know that's the problem,
you need more folate or B12,
we would address that differently than
somebody who has a chronic blood loss.
Now, the last point is a red
blood cell hemolysis.
If you've got something going on, hemo, lysis,
hemolysis, that means the destruction
of red blood cells,
you're going to have a low
red blood cell count.