How to Approach an Increased Hemoglobin Level

Polycythemia is due to an increase of red blood cell mass caused by a mutation, either acquired or inherited in red blood cell progenitor cell. It's caused by a bone marrow defect and can be physiologic or non-physiologic. Examples include increased EPO production in the setting of a patient who's hypoxic or has reduced oxygen saturation. In this patient, I would expect expiratory wheezes on exam or increased neck growth or elevated BMI.