Hematocrit rising... why?

Jun 4, 15 10:21

Post #1 of 24 (8013 views)

some background: I am participating in a medical trial for a new drug similar to Humira (A biologic for psoriasis, psoriatic arthritis etc. )
I had a baseline bloodtest in January and came back with a 44 hematocrit. I just got my May results and my Hematocrit is up to 48.
The only drugs I'm taking are either Humira or the new one that's similar. I'm not supplementing, my diet has not changed and I'm not doping or blood doping.
I am strictly a cyclist right now. In January (according to Strava), I rode about 600km, 600km in feb, 500km in March, 1000km in April (test was early May)
Any other reason that my hematocrit has risen? I know that I was in much better shape in May than I was at my baseline test in January, but nearly 10% increase in hematocrit seems like a lot. Any amateur or professional hematologists out there? I always thought hematocrit was fairly static based on genetics, but I can't seem to find anything explaining why mine might be rising. Is it simply better fitness?
Thanks in advance, ST

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 10:43

Post #2 of 24 (7955 views)

you're strictly a cyclist and your hematocrit rising. where's the aberration here?

;-) please pardon my having fun at your expense. now that my bad joke is out of the way, i'm sure you'll find folks on the forum (plenty of MDs here) who'll help you answer this.

Dan Empfield
aka Slowman

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 10:43

Post #3 of 24 (7955 views)

You could make some good money selling your supply to pro cyclists.

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 10:44

Post #4 of 24 (7954 views)

The medication could cause dehydration and hematocrit increased compared to decreased blood volume??

Regardless just make sure you are taking care to hydrate as elevated H/H can equal sludgy blood and puts you at greater risk for blood clots.

Last edited by: Ty: Jun 4, 15 10:54

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 10:54

Post #5 of 24 (7925 views)

I was going to suggest basically the same thing as Ty. When you tested in May you could have been more dehydrated. Higher temps and increased training load could cause dehydration, and from my understanding make your hematocrit read high.

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 10:57

Post #6 of 24 (7914 views)

you're using it 40 mg q.2 weeks subcu? it is also used in RA, FWIW. I work for a rheum and have not seen your n=1 with RA or psoriatic arthritis. did you check pub med for Humira+hematocrit?

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Re: Hematocrit rising... why? [sxevegan] [ In reply to ]

Jun 4, 15 10:58

Post #7 of 24 (7907 views)

you would expect to see sodium off and hemoglobin off also. anyone on Humira is going to be getting CBC and Chem 20 pretty regularly to watch. since OP didn't indicate anything but hematocrit I'm guessing that it the only marker off?

http://harvestmoon6.blogspot.com
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Re: Hematocrit rising... why? [kathy_caribe] [ In reply to ]

Jun 4, 15 12:09

Post #8 of 24 (7810 views)

all my levels are well within the normal range and there wasn't much variance other than the hematocrit.
hgb was 15.5 in Jan vs 15.8 in May
RBC was 4.8 Jan 4.9 in May

I forget what the sodium was but there wasn't much variance as I recall

Re: Hematocrit rising... why? [kathy_caribe] [ In reply to ]

Jun 4, 15 12:15

Post #9 of 24 (7789 views)

It may not be humira, it may be the new one (I'm not sure of the chemical name nor if I'm allowed to say it as it's a 3 year trial, so we'll keep it at it being similar in function to humira (T-cell)) or it may be humira

I'm on it for psoriasis, and it's a wonder drug. I'm completely clear after 10 weeks being on it. First time I've felt comfortable being shirtless in 15 years

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 12:23

Post #10 of 24 (7776 views)

You hired Alberto Salazar as your coach?

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 12:53

Post #11 of 24 (7714 views)

2 time points does not give enough information for you to know what your normal Hematocrit is.
Hydration makes a big difference, that could explain it. Or if you were iron deficient...

Maybe your 'normal' level is 46 and you have been a bit under and a bit over, next time you might be 46... no big deal.

I have taken blood from people over time points and everything varies lots, everything.

Re: Hematocrit rising... why? [NUFCrichard] [ In reply to ]

Jun 4, 15 13:07

Post #12 of 24 (7687 views)

I didn't think to check the other tests in between. I will next time (They're monthly)

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 13:23

Post #13 of 24 (7655 views)

FWIW, most all (if not all) clinical trials are public http://www.centerwatch.com/...-psoriatic-disorders

so happy that Humira is bringing you relief.

http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 15:30

Post #14 of 24 (7547 views)

I have been on Humira since fall of 2013 for my Crohn's Disease, injecting 40 mg every two weeks. I have noticed no change in my (very unimpressive) hematocrit or hemoglobin numbers in that time. I have routine blood work done every six months. When I research adverse reactions with regard to Humira, I see a lot of the opposite issues. Aplastic anemia. Myelosuppression. Not much with regard to an increase in these blood markers. I would definitely discuss this with your prescribing physician.

What I am unclear on based on reading your post is when you started these medications. I also get the impression that you're intermittently taking either one at any given time? That doesn't seem right, both in terms of an effective clinical trial as well as efficacy with regard to Humira. Are your providers aware that you are doing this?

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 16:57

Post #15 of 24 (7482 views)

It may well be a response to you getting your underlying disease under control. Depending on the details of your previous blood results and health (cell numbers, size, variability of cell size, total amount of Hb and amount per cell) you may have had an element of anaemia of chronic disease and/or some malabsorption of nutrients (humira has some effect on GI malabsorption-causing diseases). May also be a cyclic process such as:
disease under control - body works better - can produce more healthy RBC's - can train better - produce more of a stimulus for further RBC production.

(med student, not a haematologist / rheumatologist)

Re: Hematocrit rising... why? [NUFCrichard] [ In reply to ]

Jun 4, 15 17:22

Post #16 of 24 (7459 views)

NUFCrichard wrote:

2 time points does not give enough information for you to know what your normal Hematocrit is.
Hydration makes a big difference, that could explain it. Or if you were iron deficient...

Maybe your 'normal' level is 46 and you have been a bit under and a bit over, next time you might be 46... no big deal.

I have taken blood from people over time points and everything varies lots, everything.

^^^^This.

Look at your readings over time to see how these values stack up before getting too concerned. There's some natural variation due to hydration, among other factors.

Also check your diet to see if you've recently consumed any of the following:
Spanish beef
Whiskey
Your vanishing twin

ECMGN Therapy Silicon Valley:
Depression, Neurocognitive problems, Dementias (Testing and Evaluation), Trauma and PTSD, Traumatic Brain Injury (TBI)

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 4, 15 23:46

Post #17 of 24 (7342 views)

rainmaker wrote:

all my levels are well within the normal range and there wasn't much variance other than the hematocrit.
hgb was 15.5 in Jan vs 15.8 in May
RBC was 4.8 Jan 4.9 in May

I forget what the sodium was but there wasn't much variance as I recall

A quick wiki search told me that modern labs do not actually measure hematocrit (in med school a long time ago we used to measure it by putting blood in a capillary tube and spinning it in a centrifuge and then holding it up against millimeter ruler/paper), but calculate it from the red blood cell count and the mean red blood cell volume. As your RBC count has not changed (because the RBC count and the hemoglobin are the same), one explanation would be that your red blood cells are larger (higher volume, reported generally in US labs as "MCV"). This can be caused by drugs or medical conditions. Please discuss it with your doctor.

Two wheels good. Four wheels bad.

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Jun 8, 15 10:23

Post #18 of 24 (7092 views)

rainmaker wrote:

some background: I am participating in a medical trial for a new drug similar to Humira (A biologic for psoriasis, psoriatic arthritis etc. )
I had a baseline bloodtest in January and came back with a 44 hematocrit. I just got my May results and my Hematocrit is up to 48.
The only drugs I'm taking are either Humira or the new one that's similar. I'm not supplementing, my diet has not changed and I'm not doping or blood doping.
I am strictly a cyclist right now. In January (according to Strava), I rode about 600km, 600km in feb, 500km in March, 1000km in April (test was early May)
Any other reason that my hematocrit has risen? I know that I was in much better shape in May than I was at my baseline test in January, but nearly 10% increase in hematocrit seems like a lot. Any amateur or professional hematologists out there? I always thought hematocrit was fairly static based on genetics, but I can't seem to find anything explaining why mine might be rising. Is it simply better fitness?
Thanks in advance, ST

Better fitness is unlikely the reason for the increases in your Hct and Hb. Did you train mostly outside from Jan to May? Typically, Hct will fall a bit due to plasma volume expansion with endurance training in warmer weather. One baseline test and one follow-up test are not enough to base an opinion on, but consider medication-related stimulation in hemopoiesis if more tests show further increases. As previously indicated, Hct higher than 48 can be problematic.

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Dec 1, 15 12:25

Post #19 of 24 (6681 views)

Ray, I am a psoriasis sufferer as well It has gotten pretty bad and am talking with my Dr. How has this new med been working for you? Especially as an active adult...?

Re: Hematocrit rising... why? [kathy_caribe] [ In reply to ]

Dec 1, 15 13:00

Post #20 of 24 (6619 views)

kathy_caribe wrote:

you would expect to see sodium off and hemoglobin off also. anyone on Humira is going to be getting CBC and Chem 20 pretty regularly to watch. since OP didn't indicate anything but hematocrit I'm guessing that it the only marker off?

We don't do any lab monitoring for patients on Humira except an annual TB test (PPD or Quantiferon).

OP - so I take it you're either on Humira or the new drug as a blinded control trial? I doubt the rise in hematocrit is due to the drug, but as others have mentioned, it would be helpful to have other data points.

There are many new drugs coming down the pipeline for psoriasis and psoriatic arthritis. I think everyone with moderate-severe disease will be on a biologic in ten years.

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Dec 1, 15 16:38

Post #21 of 24 (6450 views)

As others have stated, hydration is a big factor. That is why i always do a urine test at the same time as the blood work, then you can compare apples to apples, or not.

And also keep in mind that you can do two tests back to back in the same hour, and get different numbers from labs. They have their own +/- in their work, and doing tests months apart can have lots of things swing the numbers. So that in itself could be most of the discrepancy, so best to get this done each time, and then you will have a lot of numbers to compare. You will know what is normal for you. I have been as high as 49.8 and as low as 44.5. The high numbers were achieved when i lived and trained at altitude, the lower ones at sea level. I usually have a number in the 47 range, but had a 45 4 months ago, and a 48.6 a couple weeks ago, so go figure?

Re: Hematocrit rising... why? [ktreen] [ In reply to ]

Dec 2, 15 5:09

Post #22 of 24 (6202 views)

ktreen wrote:

Ray, I am a psoriasis sufferer as well It has gotten pretty bad and am talking with my Dr. How has this new med been working for you? Especially as an active adult...?

rainmaker ≠ dcrainmaker :-/

-
My tiny little slice of the internets: dcrainmaker.com

Re: Hematocrit rising... why? [rainmaker] [ In reply to ]

Dec 2, 15 6:50

Post #23 of 24 (6122 views)

If your 20 min power has also increased by 9.09%...stay in the trial!!

Re: Hematocrit rising... why? [dcrainmaker] [ In reply to ]

Dec 2, 15 7:32

Post #24 of 24 (6079 views)

Yes, for the record, I am not DCRainmaker. Rainmaker was my rowing nickname as I used to be able to predict a practice that would be moved inside due to lightning. I didn't realize dcrainmaker existed when I signed up to slowtwitch in 2008 (?). My bad and apologies for any confusion caused. I have nothing but respect for Ray

re: the hematocrit rising. I have continued with the trial (for gluselkumab, not humira) and it's been awesome. I'll be in the trial for the next 2 years.

My hematocrit has normalized and is still measured monthly. it's been between 44 and 48 for every test since. looking back at my Strava, I did a 100km ride the night before the 48 hematocrit blood test, so it's easy to assume I was pretty dehydrated.

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