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Forum Name: Hematology Topics

Question: Elevated Hematocrit and Calcium Flucuations


 arrigoar - Wed May 16, 2007 1:37 pm

I am a 25 yr. old male. Since September 2006 I have been having some weird lab results. My hematocrit has been consistently elevated around 50% and my calcium has been fluctating from high normal to slightly high. The calcium ranges from anywhere between 9.8 and 11. On last check in April, my calcium was 9.8. I have had every test under the sun. Pulmonary function test, JAK 2 mutation test, renal ultrasound, SPEP, UPEP, 24 hr. urine calcium, PTH (for parathyroid function), chest x-ray, sleep study, and kidney function tests. All of the tests are normal.

My PCP referred me to a hematologist, performed two phlebotomies and my hemoglobin is now 16.5 and my HCT is 50.9%. I really have no symptoms, except for some on and off back pain. I was concerned about bone pain and myeloma, but the SPEP and UPEP were normal and my PTH was normal as well. Plus, myeloma presents with anemia. The worrisome lab results are the fluctuating calcium, high HCT and at my last hematologist visit my albumin was elevated at 5.4. I think my doctors are stumped. I am thinking it is a parathyroid problem, even though my PTH was normal. Do you have any ideas?

Thanks,

T
 Dr. Chan Lowe - Sun Jul 08, 2007 9:19 pm

User avatar I'm not sure what to make of the hemoglobin/hematocrit elevation. If, by chance, you smoke or live at a high elevation you may have a higher hematocrit (HCT) as a compensation for decreased oxygen.

There are a few conditions known as polycythemias that can present with elevated HCT. I am less familiar with them as they are fairly rare. Your hematologist would be better able to advise you about these.

In regards to your calcium I think you may be chasing a "false" number. Total blood calcium is very much related to protein levels. If your albumin is elevated it will make your total blood calcium levels increase. The actual number of interest with calcium is the ionized (or active) calcium. Often, the total calcium will be low or high but the ionized calcium will be normal. I would recommend you have your ionized calcium level checked if there is concern.

Best wishes.

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