Chris Kresser: No, I don’t think you’re overthinking this. I think it’s our job as functional medicine providers to follow up on abnormal findings like this. I’ve used several examples now in the course of where I’ve diagnosed people with things like Wilson disease or hemochromatosis just despite the fact that they had been seeing conventional clinicians for many years and have had abnormal lab markers all along the way that were completely ignored. So given that, because of the additional time that we spend with patients, we often will catch things that other clinicians in the primary care setting and where things are moving a lot more quickly will miss.
So persistently elevated hemoglobin, red blood cells, and hematocrit you need to consider things like polycythemia vera, which is a bone marrow disease that leads to an increase in the number of red blood cells. And there are primary causes of polycythemia and there are secondary causes. But if the red blood cell indices are persistently elevated, which it sounds like they have been, I think you’d want to at least rule that out. Some of the symptoms include trouble breathing when lying down, bleeding, headache, itchiness, shortness of breath, fatigue, some skin spots, vision problems. And I’ve seen this, I caught this in one patient and she really didn’t have super-significant, those symptoms were not pronounced in her and she just presented like any of our other patients with the typical complaints. So given that you’ve seen this on a couple different blood panels, I might refer out to a hematologist for further workup.