Is high red blood cell count in children and newborns dangerous

High red blood cell count in children and newborns is one of the health issues that often causes parents a lot of concern. Red blood cells are responsible for carrying oxygen to all the body’s cells, and any abnormal increase in their levels can be a sign of an underlying problem that needs medical attention. In this article from Dalily Medical, we’ll explore together the causes of high red blood cells in children, the possible symptoms, whether it’s truly dangerous, and how parents can deal with it to ensure their children’s safety and health.

What is High Red Blood Cell Count in Children?

High red blood cell count, also called polycythemia or erythrocytosis, means an increase in the number of red blood cells above the normal range. This condition makes the blood thicker (more viscous), and it becomes more noticeable when the hematocrit level rises above 65%, especially in newborns.

How Can You Tell if Your Child Has High Red Blood Cells?

Diagnosis is confirmed with a simple blood test, but there are signs parents should watch out for:

Unusually red or flushed skin.
Excessive sleepiness or lethargy.
Difficulty feeding or poor appetite.
Tremors or slight shaking.
In severe cases, seizures may occur.

Is Polycythemia Dangerous?

Not always. Some cases are mild and temporary, resolving quickly with treatment. But if it’s linked to chronic or genetic conditions, regular follow-up with a specialist is essential.

Can a Baby Be Born with Polycythemia?

Yes, it often happens due to low oxygen levels during pregnancy or problems with the placenta. In many cases, it gradually improves with regular monitoring after birth.

Symptoms Parents Should Notice

Noticeable redness or paleness of the skin.
Headaches or dizziness in older children.
Poor concentration and easy fatigue.
In infants: excessive sleepiness and weak feeding.

Does a Child with Polycythemia Need a Special Diet?

Yes, a healthy balanced diet is important. The child should:

Drink enough water throughout the day.
Avoid very fatty or sugary foods.

Can Polycythemia Affect a Child’s Growth?

In severe untreated cases, it may reduce oxygen delivery to organs, which can affect growth. But with proper treatment and follow-up, most children grow normally.

Does the Child Need Lifelong Medication or Vitamins?

Not always. Treatment depends on the cause and type of polycythemia. Some children need temporary treatment, while others require longer follow-up.

Can a Child Live a Normal Life with Polycythemia?

Absolutely. Most children can live completely normal lives with proper treatment and monitoring, as long as parents follow the doctor’s advice and watch for symptoms.

Is Polycythemia Genetic?

In some cases, yes. Primary polycythemia is linked to genetic mutations. But in many cases, it’s acquired due to conditions like oxygen deficiency or other health issues.

Does Polycythemia in Newborns Disappear on Its Own?

Yes, if it’s related to pregnancy or delivery factors, it often improves gradually after birth with medical monitoring.

Can Dehydration Make It Worse?

Yes. Dehydration makes blood thicker, which can worsen symptoms or increase complications.

Does the Child Need Regular Blood Tests?

Yes, regular complete blood count (CBC) tests are crucial to monitor stability and decide if medical intervention is needed.

Can Polycythemia Cause Blood Clots in Children?

In very severe and untreated cases, the risk of blood clots may increase, but this is rare and can be controlled with the right treatment.

Is Exercise Good for Children with Polycythemia?

Yes, light physical activity suitable for the child’s age helps improve circulation. However, it should always be under medical supervision.

Can Polycythemia Be Completely Cured?

It depends on the cause:

If it’s due to temporary factors like low oxygen or a minor issue, full recovery is very possible.
If it’s genetic or chronic, it usually requires long-term monitoring.

Are There Foods the Child Should Avoid?

Yes, very fatty meals and fast food are not recommended as they affect blood and circulation. A balanced diet with vegetables, fruits, proteins, and whole grains is best.

Types of Polycythemia in Children

Primary Polycythemia
- Cause: Bone marrow problem that makes the body produce more red blood cells than normal.
- Example: Polycythemia Vera (very rare in children).
- Features:
  - Not linked to low oxygen.
  - May also involve an increase in white blood cells or platelets.
Secondary Polycythemia
- Cause: Body’s response to low oxygen or increased production of the hormone erythropoietin (EPO).
- Examples:
  - Congenital heart disease.
  - Chronic lung diseases.
  - Living at high altitudes.
  - Kidney tumors or disorders that increase EPO secretion.
- Features: Increase in red blood cells as a way to compensate for oxygen deficiency.
Relative Polycythemia
- Cause: Not a real increase in red blood cells, but a decrease in plasma volume, making blood more concentrated.
- Examples:
  - Severe dehydration.
  - Loss of fluids due to frequent diarrhea or vomiting.
- Features: Condition improves after proper hydration.
Transient (Neonatal) Polycythemia
- Cause: Occurs in some newborns due to:
  - Extra blood transfer from the placenta.
  - Maternal diabetes or high blood pressure.
- Features:
  - Usually temporary.
  - Appears within the first few days after birth.

Causes of Polycythemia in Children

Polycythemia in children means the number of red blood cells is higher than normal. This can make the blood more viscous and may lead to health problems if untreated. The causes are divided into three main categories:

Primary Causes (Bone Marrow–Related)
- Bone marrow disorders: The marrow produces more red blood cells than normal.
- Genetic causes: Certain genetic mutations cause abnormal secretion of erythropoietin.
Secondary Causes (Most Common in Children)
The body produces more red blood cells as a reaction to low oxygen. Main reasons include:
- Chronic respiratory problems, such as severe asthma or lung diseases.
- Congenital heart diseases, which reduce oxygen in the blood.
- Living in high-altitude areas, where oxygen levels are lower.
- Carbon monoxide exposure, e.g., secondhand smoke.
- Kidney diseases that increase erythropoietin production.
Other Rare Causes
- Tumors that secrete erythropoietin.
- Severe temporary dehydration, which makes blood more concentrated and looks like a rise in red blood cells.

Symptoms of Polycythemia in Children

Symptoms vary depending on severity and the cause. Sometimes children show no signs early on, but as blood viscosity increases, the following may appear:

General Symptoms
- Fatigue and persistent tiredness.
- Frequent dizziness or headaches.
- Pale or overly red skin and face.
- Poor appetite.
Nervous System Symptoms
- Difficulty concentrating or poor attention.
- Blurred or double vision.
- Tingling or numbness in hands and feet.
Circulatory Symptoms
- Cold hands and feet.
- Mild swelling in the limbs.
- Sometimes high blood pressure.
Respiratory Symptoms
- Shortness of breath, especially during exertion.
- Blue lips or fingertips (especially if caused by low oxygen or heart disease).
Additional Symptoms
- Itching after a warm bath.
- Frequent nosebleeds due to high pressure in blood vessels.

Stages of Polycythemia in Children

Initial Stage (Mild Increase in RBCs)
- Slight rise in red blood cells.
- Usually no obvious symptoms.
- Often discovered by chance during a routine blood test.
Early Symptoms Stage
- Blood starts becoming thicker.
- Child may complain of:
  - Frequent headaches.
  - Dizziness or quick fatigue.
  - Redness of the face or limbs.
- Symptoms are not severe but noticeable.
Moderate Symptoms Stage
- Blood flow becomes slower.
- Symptoms increase:
  - Abdominal pain.
  - Poor concentration and focus.
  - Tingling in limbs.
  - Poor appetite or slow growth.
Complications Stage
- Happens in severe or untreated cases.
- May cause:
  - Small blood clots.
  - Heart or lung problems (especially with secondary causes).
  - Enlarged liver or spleen.
Chronic Stage
- If left untreated long-term.
- Higher risk of serious long-term complications.
- Requires close monitoring with a hematologist and other specialists depending on the cause.

Complications of Polycythemia in Children

Circulatory System
- Blood clots due to slow circulation.
- Poor blood flow → cold extremities, slow growth of nails or hair.
- High blood pressure in some children.
Heart
- Strain on the heart muscle.
- Risk of heart enlargement or weakened function if persistent.
Nervous System
- Severe, frequent headaches.
- Dizziness or fainting due to low blood flow to the brain.
- In extreme cases: higher risk of stroke.
Lungs and Breathing
- Shortness of breath, especially during activity.
- Blue lips and fingertips if oxygen is low.
Growth and Development
- Delayed physical growth due to reduced oxygen and nutrient delivery.
- Poor concentration or learning difficulties.
Other Effects
- Skin itching after warm showers.
- Nose or gum bleeding due to high blood pressure.
- Enlarged liver or spleen.

Diagnosis of Polycythemia in Children

Medical History & Clinical Examination
- Ask parents about chronic conditions (heart, lung, kidney).
- Check for symptoms (headaches, dizziness, skin redness).
- Family history of blood disorders.
- Full exam: blood pressure, heart rate, liver/spleen enlargement, skin and limbs.
Basic Blood Tests
- Complete Blood Count (CBC): to check red blood cells, hemoglobin, and hematocrit.
- Oxygen levels: measured with a test or pulse oximeter.
- Erythropoietin (EPO) levels: helps differentiate between primary and secondary cases.
Additional Tests
- Liver and kidney function tests.
- Imaging (ultrasound, echocardiogram, chest scans).
- Genetic testing if hereditary causes are suspected.
Differentiating Types
- Primary: Low EPO.
- Secondary: High EPO with diseases or oxygen deficiency.
- Relative: Normal RBCs but low plasma due to dehydration or fluid loss.

Treatment of Polycythemia in Children with Medications

Treatment depends on the type and cause. Not all children need the same drugs. Doctors create a plan after proper tests.

Primary Polycythemia (Polycythemia Vera – extremely rare in children)
- Hydroxyurea: commonly used to control red blood cell production.
- Interferon-alpha: relatively safe for children and effective long-term.
Secondary Polycythemia
- Main approach: treat the underlying cause (e.g., heart or lung disease).
- Supportive medications:
  - Oxygen therapy: if caused by low oxygen.
  - Low-dose Aspirin: reduces blood thickness and prevents clots (used with extreme caution under medical supervision).
Other Supportive Treatments Depending on the Case
- Iron supplements: if there is associated iron deficiency.
- Blood pressure or heart medications: if complications appear.
- Diuretics: if relative polycythemia is caused by dehydration or low plasma.

⚠️ Important Note:

These medicines must only be prescribed by a pediatric hematologist.
Dosages depend on the child’s age, weight, and type of polycythemia.
In some cases, phlebotomy (removing a small amount of blood) is needed to reduce blood thickness.

Treatment of Polycythemia in Children with Vitamins

Vitamins are not a direct cure but support blood health and overall growth, especially if nutritional deficiencies exist.

Vitamin B12
- Essential for normal red blood cell formation.
- Deficiency can cause abnormal cell production and worsen symptoms.
- Taken as injections or tablets according to the doctor’s advice.

Key Vitamins for Managing Polycythemia in Children

2️⃣ Folic Acid (Vitamin B9)

Helps the bone marrow produce healthy red blood cells.
Very important in cases where the bone marrow is under extra strain.

3️⃣ Vitamin C

Improves iron absorption from food.
Strengthens immunity and reduces fatigue.
Especially useful if the child has poor nutrition or iron deficiency.

4️⃣ Vitamin D

Supports bone health and bone marrow function.
Some studies suggest it helps balance the immune system and reduce inflammation.

5️⃣ Multivitamins

Prescribed if the child has poor appetite or malnutrition.
Help compensate for deficiencies in essential vitamins and minerals.

Tips for Using Vitamins in Children with Polycythemia

Consult the doctor first: Never give your child vitamins on your own. Only a pediatrician can decide the right type and dosage.
Stick to the prescribed dose: Excessive intake of vitamins like Vitamin C or iron may harm the liver or kidneys.
Diversify the diet:
- Meat, poultry, and eggs → rich in Vitamin B12.
- Dark leafy vegetables → source of folic acid.
- Citrus fruits and tomatoes → high in Vitamin C.
- Dairy products + safe sun exposure → provide Vitamin D.
Remember supplements are not a substitute for food: Natural food is the foundation; vitamins are just supportive.
Regular blood tests: Complete blood count (CBC) + liver and kidney function tests should be checked regularly.
Monitor symptoms: If fatigue, headaches, or other signs persist, consult the doctor immediately.
Consistency matters: The effects of vitamins appear gradually, so patience and commitment are essential.