40F - Rising RBC, hemoglobin and high HCT values with low ferritin
40F, no medications, 7 months postpartum.
Vaginal delivery.
Prolonged postpartum bleeding.
Two D&Cs for retained products/postpartum complications.
Hospitalized for postpartum uterine infection and received IV antibiotics.
Continued bleeding after the D&Cs.
My menstrual periods have been heavier than before pregnancy.
Recent labs:
Ferritin: 12 (iron infusion scheduled in about 1.5 weeks)
Hemoglobin: 15.0
Hematocrit: 44.5**%** (lab upper limit 44.4%)
RBC: 5.03 (upper end of normal)
MCV: 89
WBC: 4.97
Platelets: 317
CBC trend:
Dec 2025 (shortly after postpartum bleeding): Hgb 12.2, Hct 36.2, RBC 4.09
Feb 2026: Hgb 14.0, Hct 42.8, RBC 5.02
Mar 2026: Hgb 13.8, Hct 42.1, RBC 4.98
Jun 2026: Hgb 15.0, Hct 44.5, RBC 5.03
Symptoms:
Fatigue
Restless legs
Easy bruising
Itching (not always related to showers)
Should the upward trend in my hemoglobin, hematocrit, and RBC despite low ferritin raise concern for a myeloproliferative disorder such as polycythemia vera, or does this look more like normal postpartum recovery plus iron deficiency? Would you recommend any additional evaluation (such as repeating the CBC later, erythropoietin level, or JAK2 testing), or would you simply monitor these values?