caliper

I have declared myself a medical mystery (though i suspect I may have a liver problem going).

For the last 5 years, all my CBCs had - HGB/HCT/RBC as elevated or borderline high normal. HCT usually around 50%, RBC around 5.8, HGB around 17. WBC around 6. Total Billirubin around 2.0(elevated).

A CAT Scan done 1.5 years ago (for an unrelated reason) showed border-line enlarged spleen.

I self-referred myself to a Hemotologist (though my PCP did not think it was necessary).

The Hemotologist suspected Polycythemia Vera and ran the JAK2 on me (came back not detected). That usually rules out Polycthemia Vera, though with about 80% confidence level. My Hemotologist did another CBC in the office and this time my WBC was also elevated to 11 along with the elevated HGB/HCT/RBC. Looking back, I have had all classic symptoms of Polycythemia like burning/prickling in fingers and toes even though I did not realize it at the time.

Anyways, the Hemotologist told me to try and start drinking more water to see if it helps. So I go back home and start drinking about 3 litres of water everyday.

Then about two weeks ago I visit the ER with chest heaviness, shortness of breath. They do a CBC and guess what :
WBC : 6.6
RBC : 5.1
HCT : 47
HGB : 15.x

I said "wow" at my numbers....may be it was the dehydration causing the polycythemia. But I still found it difficult to believe that my numbers would suddenly improve so much (after 5 years) just by drinking water.


Then last week, I began to notice that even though I drank a lot of water, I did not pee that much (i.e. Output Not Equal to Input). Then one evening when I did not pee much after drinking 1 litre of water, i got panicky and revisited the ER.

They did another CBC and other blood chemistry. This time my counts were :

WBC : 4.7
RBC: 4.9
HCT: 45
HGB : 14.9

So, it looks like all my CBC counts are suddenly hurtling down....and this rate I might actually develop Anemia.

One other thing is that my Total Billirubin always comes back mildly elevated which my PCP dismisses as insignificant.

So at this stage, I think I might have 2 issues going.
A Bone Marrow that has gone wild ("spent" phase of Polycythemia Vera - I dont know)
or I have a liver disease ?

Any thoughts ?

Also, I have another question, If somebody really had Polycythemia Vera, can an infection (bacterial or viral) still cause Anemia like it might do to people who don't have PV.