Inadequate treatment of excessive erythrocytosis

Abstract

Patients with Chronic Mountain Sickness or Excessive Erythrocytosis (EE) are permanent residents of high altitude 3600 m, and have red blood cell counts (RBC) above 6.5 x 10⁶ and appear cyanotic. This causes aesthetic and psychological problems in their life. Occasionally, observers may believe they are alcoholics. When RBC are increased, they search for a miraculous cure. According to several previously evolved concepts of EE, treatments have included: leeches, marrow radiotherapy by administration of radioactive substances like phosphorous, and more recently, phlebotomies, tea, infusions, garlic tablets and most dangerousley, administration of a previously prohibited cytotoxic agent, phenylhydrazine. One concept of providing treatment for EE patients is to permanently destroy their RBC_s. However, the effect of phenylhydrazine usage is toxic for the bone marrow, the liver and other tissues changing the color of the skin from cyanotic to yellow, with jaundice. The conjunctivae of the eyes become icteric and tic urine becomes dark brown. Once started on treatment, patients are tested periodically and their RBC count indeed diminishes, and they may feel satisfied. However this toxic medication may have a fatal outcome. By reducing the number of RBC_s, the arterial oxygen content (CaO₂) of the blood is diminished. We have found the majority of patients with EE to have abnormal chest x-rays. Ergometric testing of these patients may produce severe oxygen debt. In one of the patients, on the 4th stage of the Bruce Protocol , intense pain in both legs gradually became intolerable and he required post-exercise oxygen. Following interruption of the phenylhydrazine, CaO₂ returned to normal in approximately 60 days. with a rise of RBC_s slightly y above previous levels. The patient experienced no symptoms of illness. This case and multiple other cases have lead us to believe that EE is a compensating mechanism for lung disease at high altitude and that the RBC mass should not be decreased.