Blood Too Thick? Why Polycythemia Vera Happens & Medical Next Steps

If you've been told your blood is "too thick" or that your red blood cell count is high, you may have heard the term polycythemia vera. It can sound alarming, but understanding what it is — and what to do next — can help you move forward with clarity and confidence.

This guide explains what polycythemia vera is, why it happens, common symptoms, how it's diagnosed, and what medical steps typically follow.

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What Is Polycythemia Vera?

Polycythemia vera (PV) is a rare, chronic blood disorder. It's classified as a type of blood cancer known as a myeloproliferative neoplasm. In simple terms, your bone marrow — the soft tissue inside your bones — makes too many red blood cells.

Red blood cells carry oxygen throughout your body. But when you have too many, your blood becomes thicker than normal. Thick blood moves more slowly and is more likely to form clots.

Over time, this can increase the risk of:

• Blood clots (deep vein thrombosis or pulmonary embolism)
• Stroke
• Heart attack
• Enlarged spleen
• Other blood disorders

Polycythemia vera usually develops slowly and may not cause noticeable symptoms at first. Many people are diagnosed after routine blood work.

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Why Does Polycythemia Vera Happen?

In most cases, polycythemia vera is caused by a mutation (change) in a gene called JAK2.

Here's what happens:

• The JAK2 gene normally helps control blood cell production.
• A mutation causes the bone marrow to keep making red blood cells — even when the body doesn't need them.
• The production becomes excessive and unregulated.

Important facts:

• Over 90% of people with polycythemia vera have a JAK2 mutation.
• It is not usually inherited.
• It is not caused by lifestyle, diet, or stress.
• It most commonly appears after age 60, though younger adults can develop it.

There is currently no known way to prevent polycythemia vera.

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Symptoms of Polycythemia Vera

Symptoms can vary. Some people feel fine for years. Others develop noticeable problems.

Common symptoms include:

• Headaches
• Dizziness or lightheadedness
• Blurred vision
• Fatigue
• Itching, especially after a warm shower or bath
• Reddened skin (especially face)
• Night sweats
• Ringing in the ears
• Shortness of breath
• Numbness or tingling in hands and feet

More serious signs may include:

• Chest pain
• Sudden weakness
• Trouble speaking
• Swelling or pain in the leg
• Severe abdominal discomfort (from enlarged spleen)

These symptoms can signal a blood clot and require urgent medical attention.

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How Is Polycythemia Vera Diagnosed?

Doctors typically suspect polycythemia vera after abnormal blood test results show:

• High red blood cell count
• Elevated hemoglobin or hematocrit levels
• Sometimes high white blood cells and platelets

If PV is suspected, further testing may include:

• JAK2 mutation test
• Bone marrow biopsy
• Erythropoietin (EPO) level testing
• Imaging tests to check spleen size

Diagnosis is based on a combination of lab results and genetic findings.

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Polycythemia Vera vs. Other Causes of Thick Blood

Not all cases of high red blood cell counts mean polycythemia vera.

Other possible causes include:

• Dehydration
• Smoking
• Chronic lung disease
• Living at high altitude
• Kidney disease
• Testosterone therapy

These are considered secondary polycythemia, meaning the body is responding to low oxygen levels or another trigger.

Certain inherited blood disorders can also affect red blood cells. For example, Sickle Cell Disease changes the shape of red blood cells and can lead to serious complications. If you're experiencing unexplained blood-related symptoms and want to better understand what might be causing them, a free online symptom checker can help you identify whether you should discuss specific conditions with your doctor.

However, only a doctor can confirm a diagnosis.

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Is Polycythemia Vera Dangerous?

Polycythemia vera is a serious condition — but it is often manageable with proper treatment.

The biggest risks come from:

• Blood clots
• Bleeding complications
• Progression to myelofibrosis (bone marrow scarring)
• Rarely, transformation into acute leukemia

The good news is that with modern treatment, many people live for decades after diagnosis. Early detection and consistent medical care make a significant difference.

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Medical Next Steps After Diagnosis

If you are diagnosed with polycythemia vera, your doctor will develop a treatment plan based on:

• Your age
• History of blood clots
• Overall health
• Blood counts

1. Phlebotomy (Blood Removal)

This is often the first treatment.

• A small amount of blood is removed regularly.
• This lowers red blood cell levels.
• It reduces blood thickness.
• It helps decrease clot risk.

It's similar to donating blood but done under medical supervision.

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2. Low-Dose Aspirin

Many patients are prescribed low-dose aspirin to:

• Reduce clotting risk
• Improve blood flow

This should only be taken under medical guidance.

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3. Medications to Reduce Blood Cell Production

If phlebotomy alone isn't enough, doctors may prescribe medications such as:

• Hydroxyurea
• Interferon
• JAK inhibitors (for certain cases)

These medications help slow bone marrow activity.

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4. Lifestyle Support

While lifestyle changes cannot cure polycythemia vera, they can reduce complications:

• Stay hydrated.
• Avoid smoking.
• Maintain healthy blood pressure.
• Stay physically active (as advised by your doctor).
• Report new symptoms quickly.

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When to Seek Immediate Care

Call emergency services or seek urgent medical attention if you experience:

• Sudden chest pain
• Shortness of breath
• Sudden weakness on one side
• Trouble speaking
• Severe leg swelling or pain
• Sudden vision changes

These may indicate a blood clot or stroke.

Do not ignore these symptoms.

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Living With Polycythemia Vera

Being diagnosed with a chronic blood condition can feel overwhelming. However:

• Many patients live long, productive lives.
• Treatment has improved significantly.
• Ongoing monitoring helps prevent major complications.

You will likely need regular blood tests and follow-up visits with a hematologist (blood specialist).

Consistency matters. Skipping follow-up appointments increases risk.

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Key Takeaways About Polycythemia Vera

• Polycythemia vera is a rare blood cancer that causes too many red blood cells.
• It is usually caused by a JAK2 gene mutation.
• Thickened blood increases the risk of clots.
• Many people are diagnosed through routine blood tests.
• Treatment often includes phlebotomy, aspirin, and medication.
• With proper management, outcomes can be good.
• Sudden symptoms like chest pain or stroke signs require emergency care.

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Final Thoughts

If you've been told your blood is thick or your red blood cell count is elevated, do not panic — but do take it seriously. Polycythemia vera is a condition that requires medical evaluation and long-term management.

If you are experiencing symptoms or have abnormal lab results, speak to a doctor promptly. Blood disorders can become life-threatening if ignored.

The right next step is not guessing — it's getting medical guidance.

If anything you're experiencing feels severe, sudden, or concerning, seek urgent care immediately. Your health and safety come first.