Doctor investigating secondary polycythemia
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Age: 38
Gender: Female
Type of Doctor You Are Seeing: PCP (primary care)
Reason My Doctor Suspects an MPN / what’s going on:
My PCP is sending me for more tests and used ICD-10 D75.1 (Secondary polycythemia). I also noticed “secondary polycythemia” was added to my chart/problem list, but we haven’t discussed it yet. This seems to be a workup for why my hematocrit/hemoglobin/RBC have been intermittently high for years, plus platelets often high or high-normal. No mutation testing or bone marrow biopsy yet. My doc also had her due date Thursday so I'm sure she's busy.
- Available Test Results + reference ranges (chronological order, this took me a long time to write up):
01/22/2021 (CBC):
WBC 7.4 (3.8–10.8 Thousand/µL).
RBC 5.76 **H** (3.80–5.10 Million/µL).
Hgb 15.7 **H** (11.7–15.5 g/dL).
Hct 48.3 **H** (35.0–45.0%).
Platelets 455 **H** (140–400 Thousand/µL).
04/05/2021 (CBC):
WBC 8.1 (3.8–10.8 Thousand/µL).
RBC 5.27 **H** (3.80–5.10 Million/µL).
Hgb 14.8 (11.7–15.5 g/dL).
Hct 45.2 **H** (35.0–45.0%).
Platelets 464 **H** (140–400 Thousand/µL).
11/12/2021 (CBC + EPO + ferritin) (I ordered these myself):
WBC 8.0 (3.8–10.8 Thousand/µL).
RBC 5.66 **H** (3.80–5.10 Million/µL).
Hgb 15.5 (11.7–15.5 g/dL).
Hct 46.8 **H** (35.0–45.0%).
Platelets 457 **H** (140–400 Thousand/µL).
EPO 3.7 (2.6–18.5 mIU/mL).
Ferritin 72 (16–154 ng/mL).
05/15/2023 (CBC):
WBC 8.2 (3.8–10.8 Thousand/µL).
RBC 5.67 **H** (3.80–5.10 Million/µL).
Hgb 15.6 **H** (11.7–15.5 g/dL).
Hct 47.3 **H** (35.0–45.0%).
Platelets 427 **H** (140–400 Thousand/µL).
(Also had hs-CRP >10 around then; I had a concussion around that time.).
09/25/2023 (CBC):
WBC 8.4 (3.8–10.8 Thousand/µL).
RBC 5.45 **H** (3.80–5.10 Million/µL).
Hgb 15.1 (11.7–15.5 g/dL).
Hct 45.9 **H** (35.0–45.0%).
Platelets 452 **H** (140–400 Thousand/µL).
04/29/2024 (CBC):
WBC 8.1 (3.8–10.8 Thousand/µL).
RBC 5.09 (3.80–5.10 Million/µL).
Hgb 13.7 (11.7–15.5 g/dL).
Hct 42.5 (35.0–45.0%).
Platelets 418 **H** (140–400 Thousand/µL).
11/11/2024 (CBC) — weight ~100 kg / 220 lb:
WBC 6.4 (3.4–10.8 x10E3/µL).
RBC 5.73 **H** (3.77–5.28 x10E6/µL).
Hgb 15.5 (11.1–15.9 g/dL).
Hct 48.8 **H** (34.0–46.6%).
Platelets 408 (150–450 x10E3/µL).
A1c 5.7 **H** (4.8–5.6%) this was enough to add prediabetes on my chart :(.
02/28/2025 (CBC) — weight ~180 lb:
WBC 9.0 (3.4–10.8)
RBC 5.23 (3.77–5.28).
Hgb 14.5 (11.1–15.9).
Hct 44.2 (34.0–46.6).
Platelets 428 (150–450)
A1c 5.5 (4.8–5.6) my prediabetes resolved with weight loss
08/06/2025 (Iron/TIBC/Ferritin) I had hair loss from weight loss and we were just checking it wasnt anything else, I weighed around 150-140 I think:
Iron 47 (27–159 µg/dL)
TIBC 272 (250–450 µg/dL)
Iron saturation 17% (15–55%)
Ferritin 239 **H** (15–150 ng/mL)
02/13/2026 (CBC) — weight ~140 lb:
WBC 7.6 (3.4–10.8)
RBC 5.66 **H** (3.77–5.28)
Hgb 16.1 **H** (11.1–15.9)
Hct 48.0 **H** (34.0–46.6)
Platelets 464 **H** (150–450)
EPO / mutations / biopsy:
EPO: 3.7 (normal range above)
JAK2/CALR/MPL: not tested yet
Bone marrow biopsy: not done
Tests my PCP has ordered now (ICD-10 D75.1): CBC w/ differential + platelet Fe + TIBC + Ferritin
- How long counts have been high:
At least since Jan 2021 (4+ years). Hct/Hgb are intermittently high; platelets often elevated.
Other relevant history / possible secondary causes:
I don’t think I have sleep apnea (no snoring); spouse does have OSA.
Well-controlled asthma; lungs sound great. I'm a non-smoker; live near sea level; working CO detectors.
BP tends to be low/normal (e.g., 104/62 today).
IST treated with low-dose beta blocker (metoprolol 6.25 mg/day, tapering down from 12.5 mg/day).
Prior NAFLD on ultrasound (now improved/reversed); I largely quit alcohol to help liver. I do still drink on occassion
Significant weight loss since Nov 2024.
Question: With this pattern (high Hct/Hgb at times + platelets in the 400s for years, normal EPO), does this look more like secondary/relative erythrocytosis + reactive thrombocytosis, or does it warrant MPN testing (JAK2 etc.)?