Dear Mike,
If this girl really has a Hb of 24 g/dL, her Ht must be around 0.7
somewhere. Patients with values that high usually suffer from the
hyperviscosity syndrome, because the Ht is closely and
exponentially linked to whole blood viscosity (see e.g. Wintrobe).
The hyperviscosity syndrome is consists of headaches,
neurological and retinal symptoms which in extreme cases can
lead to blindness. Our pediatricians occasionally have newborns
with an Ht>0.65 which are then bleeded to obtain lower values.
Patients with hyperviscosity have an increased chance of
myocardial infarction and stroke and mortality therein. Evidence
can be found in the literature.
In our view, the cause of the high Hb could be polycythemia vera
(hence the EPO) or sleep apnoe (enhanced by a Pickwick
syndrome, as I understand) leading to nocturnal hypoxia enhancing
erythropoiesis.
We would therefore strongly advise to bring down her Hb, despite
her needle phobia. As an alternative you could propose the old
fashioned use of leeches, which could bring her to accept
venesection. I do not know if your regional blood bank would accept
her as a donor.
Best regards,
Raymond Wulkan
Zuiderziekenhuis
Rotterdam-NL
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