home Analyzes What does high bilirubin mean? Why ESR may be higher than normal and what does this mean?

What does high bilirubin mean? Why ESR may be higher than normal and what does this mean?

Menstrual irregularities and inability to conceive are typical indicators of trouble reproductive system among women. They are the ones who are the most common reasons contacting a gynecologist. Almost always these conditions are associated with a violation normal values hormone prolactin. What causes the rise of this hormone and how to deal with it?

An increase in prolactin levels in the blood is medically called hyperprolactinemia. Most often, hyperprolactinemia occurs in young women (under 40 years of age), less often in men of the same age.

Causes of elevated prolactin levels in women

High prolactin levels in women have different causes:

Physiological - do not pose a danger, they accompany normal processes.
Pathological - are a consequence of the disease.

An increase in prolactin levels in the blood is completely normal:

during sleep at any time of the day;
with severe physical activity in its anaerobic part;
in the late phase of the menstrual cycle;
with nipple irritation and sexual intercourse;
when eating protein foods;
during pregnancy and immediately after childbirth. At this time, prolactin levels increase 150-200 times, a real hormonal changes, characteristic only for this period.

The causes of pathological increase, in turn, are divided into primary and secondary:

Primary hyperprolactinemia is caused by diseases of the brain, primarily the hypothalamus and pituitary gland (for example, tumors).
Secondary hyperprolactinemia is caused by endocrine disorders and a row medicines(contraceptives, antipsychotics, antiemetics, cimetidine). In the latter case, hyperprolactinemia is called drug-induced.

Secondary hyperprolactinemia may result from:

Common to all forms of hyperprolactinemia is the unbalanced functioning of the hypothalamic-pituitary-reproductive system, which has a negative impact on a woman’s reproductive function.

Prolactin in the blood exists in several forms:

monomeric;
dimeric;
macroprolactin (polymer);
glycosylated.

Of clinical importance is the biologically active fraction - monomeric prolactin with a low molecular weight. General content prolactin in the blood may increase due to other fractions, for example, macroprolactin, but this increase is not accompanied clinical symptoms. If a woman has increased monomeric prolactin, we can talk about the signs and consequences of hyperprolactinemia.

Symptoms and consequences of elevated prolactin in women

Clinical symptoms of hyperprolactinemia can be very different. The leading complaints are:

for irregularity or absence of the menstrual cycle;
inability to get pregnant;
complete frigidity;
galactorrhea - the release of milk from the mammary glands, not associated with feeding the child.

However, there may be no symptoms at all.

Short-term effects of high prolactin levels include:

galactorrhea;
menstrual disorder;
swelling and tenderness of the mammary glands;
increased appetite and body weight.

Over time, the following diseases may develop:

osteoporosis;
heart diseases;
cancer of the pituitary gland and ovaries.

High prolactin levels increase cholesterol levels, which increases the risk coronary disease heart disease, hypertension, obesity and diabetes during the period.

With age, prolactin levels decrease, which leads to the appearance of “panic attacks.” During crises in menopause panic attacks manifest themselves in the form of a feeling of fear of death, chills, agitation, and pressure changes.

Increased prolactin in women when planning pregnancy necessarily requires consultation with an obstetrician-gynecologist. As stated above, high level this hormone can cause infertility. Lack of pregnancy and impaired menstrual cycle- Frequent complaints of women when visiting doctors. The most common cause is pituitary prolactinoma. In this case, women are usually prescribed a yearly course of treatment and are advised to protect themselves from pregnancy.

How to treat elevated prolactin in women

For prolactinomas of the pituitary gland they are used different types treatment:

surgical;
medicinal;
irradiation.

Prolactin levels are well normalized with medication. For this purpose, dopamine receptor stimulants are used. There are three generations of them:

The first generation - "Bromocriptine" - is gradually becoming a thing of the past due to its short period of action. To reduce side effects taking the drug begins with tiny doses, usually before bedtime;
II generation - “Quinagolide”;
III generation - “Dostinex” or “Cabergoline”. Have less side effects, all undesirable symptoms appear weakly and disappear after 10 days of treatment, so Dostinex elevated prolactin in women it can be used for a long time and in large doses.

All drugs effectively normalize or significantly reduce prolactin, which is reflected in the size of the tumor, which gradually regresses during treatment.

Bromocriptine is the only drug that allows pregnancy during therapy. During treatment with other drugs, including Dostinex, pregnancy is contraindicated. These medications should be stopped one month before conception.

Is it possible to lower prolactin with folk remedies?

Among the variety of medicines, there is an effective and officially recognized one - this plant Agnus castus. Among his people also called twig, "monk's pepper", "Abraham's tree". The fruits of this plant form the basis of the drug "Cyclodinone".

"Cyclodinone" is so effective that when elevated level hormone up to 1000 mIU/l independently copes with pathology. Higher levels of the hormone require the addition of other dopamine agonists.

Dosage example: 40 drops orally or 1 tablet 1 time per day in the morning. The course of treatment is 3 months without a break during menstruation.

Dear women! Drug and dosage information is provided for informational purposes only. The issue of normalizing hormonal levels should be dealt with by a specialist who will have to solve many problems, from diagnosing and identifying the cause of the disease to constructing a treatment regimen. It is the doctor who must explain to the patient how to overcome the pitfalls that occur during treatment with dopamine receptor agonists in the form of adverse reactions.

Lyubov Maslikhova, therapist, especially for the site

Useful video

The erythrocyte sedimentation rate (ESR) in the blood is one of the main signs that doctors monitor when studying laboratory analysis this material. Such close attention to this indicator is due to the fact that it can serve as a sign of the presence of an inflammatory process in the body.

Normal ESR values

The rate of erythrocyte sedimentation rate in the blood directly depends on the gender and age of the person whose blood is being tested. So, the highest ESR norm usually seen in infants: It ranges from 12 to 17 millimeters per hour. The normal ESR rate for women is 3-15 mm/hour, - 1-10 mm/hour, for children - 0-2 mm/hour. In older people, the ESR rate is usually higher: it can be up to 38 mm/hour and up to 53 mm/hour in women. Therefore, if your results obtained as a result of the analysis differ significantly from these figures, you should consult a doctor to figure out what is the cause of the elevated ESR level.

ESR indicators

You can independently draw preliminary conclusions about what problems an elevated ESR level in your blood may indicate. Thus, a deviation of the result from the norm by several units is most often due to specific features your body and may not be a sign of any serious dysfunction. However, in order to make sure that the result is normal for you, it is recommended to consult a physician for advice.

If the deviation from the norm is 15-30 mm/hour, this usually indicates the presence of an inflammatory process in the body. In some cases, its presence may be obvious to you, for example, if this moment you're leaking colds. However, the existing disease may also be hidden, for example, if the liver or organs are affected gastrointestinal tract. Therefore, in this case, you should definitely consult a doctor who can prescribe additional tests for you. They will allow you to determine the nature of the disease and prescribe adequate treatment.

Even more serious is the excess ESR indicator compared with normal level by 30 units or more. In this case, specialists usually begin to suspect the presence of a progressive destructive process in organism. One of the common examples of diseases that can accompany such a significant increase in ESR levels is oncological manifestations. In such a situation, you must immediately visit a doctor who can prescribe complex treatment taking into account the nature, specificity and intensity of your disease.

A blood test for ESR is simple and inexpensive, which is why many doctors often turn to it when they need to understand whether something is going on. inflammatory process. However, reading and interpreting the results is not straightforward. I decided to ask the head of the children’s clinic about how much I can trust the ESR analysis and whether it’s worth doing it at all. So, let's listen to the expert's opinion.

Definition of reaction

ESR reflects the degree of red blood cell precipitation in a blood sample over certain period time. As a result, blood mixed with anticoagulants is divided into two layers: red blood cells are at the bottom, plasma and leukocytes are at the top.

ESR is a nonspecific, but sensitive indicator and therefore can respond even at the preclinical stage (in the absence of symptoms of the disease). An increase in ESR is observed in many infectious, oncological and rheumatological diseases.

How the analysis is done

In Russia they use known method Panchenkova.

The essence of the method: if you mix blood with sodium citrate, it does not clot, but is divided into two layers. The lower layer is formed by red blood cells, the upper layer is made up of transparent plasma. The process of erythrocyte sedimentation is associated with chemical and physical properties blood.

There are three stages in the formation of sediment:

in the first ten minutes, vertical clusters of cells are formed, which are called “coin columns”;
then it takes forty minutes to settle;
for another ten minutes the red blood cells stick together and become denser.

This means that the entire reaction requires a maximum of 60 minutes.

These capillaries collect blood to determine ESR.

For the study, take a drop of blood from a finger and blow it into a special recess on the plate, where a 5% sodium citrate solution has previously been added. After mixing, diluted blood is drawn into thin glass graduated capillary tubes to the upper mark and placed strictly vertically in a special stand. In order not to confuse the tests, a note with the patient’s name is pierced with the lower end of the capillary. Time is recorded by a special laboratory clock with an alarm. Exactly one hour later, the results are taken into account based on the height of the red blood cell column. The answer is recorded in mm per hour (mm/h).

Despite the simplicity of the technique, there are instructions that must be followed when performing the test:

take blood only on an empty stomach;
inject the flesh of the finger deep enough so that the blood does not have to be squeezed out (pressure destroys red blood cells);
use fresh reagent, dry washed capillaries;
fill the capillary with blood without air bubbles;
observe correct ratio between sodium citrate solution and blood (1:4) with stirring;
carry out the determination of ESR at an ambient temperature of 18-22 degrees.

Any violations in the analysis may lead to unreliable results. The reasons for an erroneous result should be sought in violation of the technique and inexperience of the laboratory assistant.

What affects the change in ESR level

Many factors influence the erythrocyte sedimentation rate. The main one is the ratio of blood plasma proteins. Coarsely dispersed proteins - globulins and fibrinogen promote agglomeration (accumulation) of erythrocytes and increase ESR, and finely dispersed proteins (albumin) reduce the erythrocyte sedimentation rate. Therefore, when pathological conditions accompanied by an increase in the amount of coarsely dispersed proteins (infectious and purulent-inflammatory diseases, rheumatism, collagenosis, malignant tumors) ESR increases. An increase in ESR also occurs with a decrease in the amount of blood albumin (massive proteinuria in nephrotic syndrome, impaired albumin synthesis in the liver when its parenchyma is damaged).

A noticeable effect on ESR, especially in anemia, is exerted by the number of red blood cells and blood viscosity, as well as the properties of the red blood cells themselves. An increase in the number of red blood cells, leading to an increase in blood viscosity, contributes to a decrease in ESR, and a decrease in the number of red blood cells and blood viscosity is accompanied by an increase in ESR. The larger the red blood cells and the more hemoglobin they contain, the heavier they are and the higher the ESR.

The ESR is also influenced by such factors as the ratio of cholesterol and lecithin in the blood plasma (with an increase in the cholesterol content, the ESR increases), the content of bile pigments and bile acids (an increase in their quantity helps to reduce the ESR), acid-base balance blood plasma (a shift to the acidic side reduces ESR, and to the alkaline side it increases).

ESR standards

The ESR indicator varies depending on many physiological and pathological factors. ESR values are different for women, men and children. Changes protein composition blood during pregnancy lead to an increase in ESR during this period. Values may fluctuate during the day, maximum level celebrated during the daytime.

ESR in children: read the analysis

In children, the erythrocyte sedimentation rate changes with age. The norm for ESR in children is considered to be fluctuations in the range from 2 to 12 mm/h.

In newborns, this figure is lower and is considered normal in the range of 0-2 mm/h. Maybe even up to 2.8. If the analysis results fall within this range, then there is no cause for concern.

If the baby is 1 month old, then an ESR of 2 - 5 mm/h (can be up to 8 mm/h) will be considered normal for him. As the child grows up to 6 months, this rate gradually increases: the average is from 4 to 6 mm/h (can be up to 10 mm/h).

It must be remembered that each organism is individual. If, for example, all other blood parameters are good, but the ESR is slightly too high or too low, this may be a temporary phenomenon that does not threaten health.

Up to a year, the average ESR level will be considered normal 4 - 7 mm/h. If we talk about children aged 1 - 2 years, we should keep in mind average rate 5 – 7 mm, and from 2 to 8 years – 7-8 mm/h (up to 12 mm/h). From 8 years old to 16 years old you can rely on indicators of 8 – 12 mm.

Almost any disease or injury can cause fluctuations in ESR. On the other side, elevated ESR- not always an indicator of disease.

If in the analyzes of your child ESR high, a more in-depth examination is needed.

If your child has recently suffered an injury or illness, his ESR may be high, and repeat tests to confirm this level should not frighten you. Stabilization of ESR will occur no earlier than two to three weeks. A blood test undoubtedly helps to better understand the picture of the child’s health.

ESR in women

It is immediately necessary to make a reservation that the ESR norm is a rather arbitrary concept and depends on age, the state of the body and many other different circumstances.

Conventionally, the following norm indicators can be distinguished:

Young women (20-30 years old) – from 4 to 15 mm/h;
Pregnant women – from 20 to 45 mm/h;
Middle-aged women (30-60 years old) – from 8 to 25 mm/h;
Women of advanced age (over 60 years old) - from 12 to 53 mm/h.

Norm of ESR in men

In men, the rate of erythrocyte adhesion and sedimentation is slightly lower: in a blood test healthy man ESR varies between 8-10 mm/h. However, in men over 60 years of age the value is slightly higher. At this age, the average parameter in men is 20 mm/h. A deviation in men of this age group is considered to be 30 mm/h, although for women this figure, although slightly overestimated, does not require special attention and is not considered a sign of pathology.

What diseases cause ESR to increase?

Knowing the reasons for the increase and decrease in ESR, it becomes clear why changes in this indicator occur general analysis blood at certain diseases and conditions. So, ESR is elevated in the following diseases and conditions:

Various inflammatory processes and infections, which are associated with an increase in the production of globulins, fibrinogen and proteins acute phase inflammation.
Diseases in which not only an inflammatory process is observed, but also tissue breakdown (necrosis), shaped elements blood and the entry of protein breakdown products into the bloodstream: purulent and septic diseases; malignant neoplasms; myocardial, lung, brain, intestinal infarctions, pulmonary tuberculosis, etc.
Diseases connective tissue And systemic vasculitis: rheumatism, rheumatoid arthritis, dermatomyositis, periarteritis nodosa, scleroderma, systemic lupus erythematosus, etc.
Metabolic diseases: hyperthyroidism, hypothyroidism, diabetes and etc.
Hemoblastoses (leukemia, lymphogranulomatosis, etc.) and paraproteinemic hemoblastoses (myeloma, Waldenström's disease).
Anemia associated with a decrease in the number of red blood cells in the blood (hemolysis, blood loss, etc.)
Hypoalbuminemia due to nephrotic syndrome, exhaustion, blood loss, liver disease.
Pregnancy, postpartum period, during menstruation.

Is it necessary to reduce ESR and how to do it?

Based only on the indicator of increased ESR in the blood, or vice versa, you should not prescribe treatment - this is inappropriate. First of all, an analysis is done to identify pathologies in the body and their causes are established. A comprehensive diagnosis is carried out and only after all the indicators have been collected, the doctor determines the disease and its stage.

Traditional medicine recommends reducing the sedimentation rate of corpuscles if visible reasons no health hazard. The recipe is not complicated: boil red beets for three hours (the tails should not be cut off) and drink 50 ml of the broth every morning as a preventive measure. It should be taken in the morning before breakfast for a week, usually this will lower the level, even if it is significantly elevated. Only after a seven-day break should a repeat analysis be done, which will show the level of ESR and whether it is necessary complex therapy to reduce it and cure the disease.

IN childhood Parents should not panic if the result shows an increase in ESR in the blood.

The reasons for this are as follows. In a child, an increase in the erythrocyte sedimentation rate can be observed in the case of teething, an unbalanced diet, or a lack of vitamins. If children complain of feeling unwell, then you should consult a doctor and have a comprehensive examination, the doctor will determine why the ESR test is elevated, after which the only correct treatment will be prescribed.

Blood test: opinion of a candidate of biological sciences

The production of this hormone occurs in the pituitary gland. It is responsible for stimulating the production of thyroid hormones: T3 - triiodothyronine, T4, respectively, thyroxine. The presence of these substances in the body is very important, because they perform several functions.

In particular, they are responsible for protein and carbohydrate metabolism and the functioning of the reproductive system, stomach, intestines, heart, vascular system and state of mind. It is natural, therefore, that when in the body this does not affect the human condition in the best way. TSH stimulates the production of thyroid hormones. When their levels increase, they, for their part, suppress the release of TSH. Thus, the principle of regulation can be characterized as “feedback”.

What does the norm depend on?

It does not depend on any specific reason, but on several at once. For example, if detected in a person, it indicates a reduced concentration of T3 and T4. Hyperthyroidism, on the contrary, indicates their increased concentration. If these hormones are produced too actively in the body, thyrotoxicosis, that is, poisoning, can develop. Their normal production is designated in medicine by the term “eutheriosis.”

Thyroid

Thyroid-stimulating hormone in women and men regulates the activity of the thyroid gland, although it has nothing to do with its production. That is why TSH level is checked along with thyroid hormone levels.

Taking tests

To make sure that you have increased thyroid-stimulating hormone, you need to donate blood for analysis. A few days before this, you will have to give up smoking and too much physical activity. Blood donation should take place in the morning; breakfast beforehand is prohibited. If you want to track how your hormone levels fluctuate, tests should be taken at the same time of day. Who is at risk? As a rule, thyroid-stimulating hormone is elevated in patients with thyroid pathologies. In addition, women after fifty must undergo tests every six months.

Norm standards

It should be emphasized that the norm for men and women is different. Therefore, this article will not provide specific numbers. If you want to find out what level of hormone is normal for you specifically, you will have to consult an endocrinologist. In a healthy adult, TSH levels fluctuate over a 24-hour period, with the highest levels occurring in the early morning. This is especially important when planning pregnancy.

Level too high

What does the fact that you have elevated thyroid-stimulating hormone indicate? According to experts, this is considered one of the signs mental illness. In addition, a high TSH level may indicate significant physical exercise, as well as pregnancy. In this case, you should not be afraid, but carefully monitor your hormonal levels and condition endocrine system necessary (especially before the second month). This period is considered the most important for the condition of the fetus, since it thyroid can't work independently yet.

Hemoglobin is a complex iron-containing protein found in red blood cells. Takes part in the transport of oxygen from the lungs to the cells of all organs and the removal of carbon dioxide in the opposite direction.

It can be immediately noted that a high level of hemoglobin indicates increased blood clotting, which is not positive thing. As a result of increased blood viscosity, the likelihood of producing blood clots increases; in addition, the transport of oxygen is also difficult.

To understand whether you should worry and how drastic measures to take, you need to know what indicator is considered optimal for good health. What does this mean? increased hemoglobin, and what should be done in such a situation we will consider in this material.

Norm

Normal levels of hemoglobin in the blood for women are 120-140 g/l and for men - 135-160 g/l.

The indicator may fluctuate depending on the physical and mental state. Its long-term decrease or increase compared to normal indicators indicates trouble in the body.

Increased hemoglobin in men

It may be as a result of smoking, due to the condition of the body caused by a number of diseases. For diseases such as erythrocytosis, pernicious anemia And hemolytic anemia when the composition of the blood changes.

With erythrocytosis, the number of red blood cells increases, which can be caused by disease of the kidneys, lungs, or heart. Reasons that increase hemoglobin may include artificial valves placed in the heart, cholelithiasis. a lack of folic acid, vitamin B12 due to diseases of the gastric mucosa, which is unable to absorb these necessary elements, can also help increase hemoglobin in men.

Increased hemoglobin in women

What does this mean, and what should be done? In women, elevated hemoglobin is observed quite rarely. As mentioned above, the norm is healthy women varies between 120 and 140 g/l.

It is allowed for hemoglobin to be elevated within 10-20 units; if the readings are above 20, you should be examined. The causes may be blood diseases, birth defects hearts, oncological diseases and cardiopulmonary failure.

What does a high hemoglobin level mean?

The blood component in question is contained in red blood cells produced by the bone marrow. These red blood cells have the function of carrying oxygen to various organs.

Therefore, if hemoglobin increases, most likely there is hypoxia in some area of the body ( oxygen starvation). Because of her Bone marrow produces too many red blood cells and blood viscosity increases.

Causes of high hemoglobin

Why is hemoglobin elevated, and what does it mean? Changes in such an important indicator as hemoglobin level indicate that dysfunction of certain organs and systems has occurred. Although in some cases high hemoglobin is the norm - for example, among people living in mountainous areas. This is a compensatory reaction of the body to the lack of oxygen high in the mountains.

The main reasons for increased hemoglobin in the blood of an adult, including women, are:

Not too alarming, although a negative sign, is increase in hemoglobin in smokers(as well as people who have recently been in a fire). The fact is that hemoglobin can only carry oxygen or carbon dioxide, easily replacing them with each other.
Severe dehydration increases plasma levels, and as a result, the volume of circulating blood increases. The process of dehydration itself does not increase the level of red blood cells, however, the consequences expressed in the increase in blood volume increase their concentration in general, which is also reflected in an increased level of hemoglobin.
Acquired heart defects, characterized by high pressure in the pulmonary circulation. This is most characteristic of mitral stenosis of rheumatic etiology.
Congenital heart diseases, especially defects that are accompanied by enrichment of pulmonary blood flow. In this case, the color of the skin changes with early childhood and has a bluish tint. The child often experiences shortness of breath and may develop a cough. Carrying out an ultrasound of the heart makes it possible to diagnose correct diagnosis. Treatment of such diseases with severe symptoms is only surgical.
An increase in the number of red blood cells in the blood (erythrocytosis).
Increased amount of hemoglobin in the blood plasma (hemoglobinemia).
Impaired intestinal patency.
Lung diseases and pulmonary failure.
Excess of vitamins B6 and B12 in the human body.
Oncological diseases.

Nevertheless, increased content hemoglobin in the blood can be associated not only with various types of diseases, but also with the living environment and lifestyle.

Physiological reasons

Let's consider the main reasons for increased hemoglobin, which are of external origin:

Living at high altitudes. The higher the altitude, the lower the oxygen level in the air. Because of this, the body produces as much hemoglobin as possible in order to bind the maximum amount of oxygen.
Regular being on fresh air and sports increase hemoglobin levels.
Among women external factor pregnancy, which affects the increase in hemoglobin, can be considered.
Features of the profession. The point is that sometimes work takes place in conditions of low oxygen content, and the body reacts to this condition by raising the level of hemoglobin in the blood
Use of anabolic steroids.

High hemoglobin is a less dangerous phenomenon than if the level is low, since low levels of this substance are diagnosed as anemia. However, it is worth noting that increased hemoglobin is still a reason to seek treatment. medical care, as it may indicate the presence of a serious pathology in the body.

It was noted that hemoglobin above normal increases the risk of developing cardiovascular diseases, and also often leads to the development of strokes and heart attacks.

Symptoms and consequences of high hemoglobin

With high hemoglobin, a person may not experience any symptoms, but with a long-term and significant change in this indicator with a complex concomitant diseases, the patient may have various vague symptoms that are general character and do not indicate a specific disease:

increased fatigue, lethargy;
weak appetite;
drowsiness or, conversely, problems falling asleep;
pain in the joints, bones - in the ribs, hips;
blood pressure increases;
headaches, dizziness;
itching of the skin, especially after a shower or bath;
stomach ache.
rapid formation of bruises and easy bleeding.

These signs appear on external level. But the most dangerous processes occur inside the body. There is a thickening of the blood medium, an increase in its viscosity and a decrease in the rate of circulation in the body. Because of this internal organs do not receive food. The most serious consequence– formation of blood clots and plaques that cause heart attacks and strokes.

How to lower hemoglobin in the blood

If what causes hemoglobin to increase is not associated with serious pathologies, then you can influence high hemoglobin with a certain diet or medicines. Among pharmaceutical drugs, located in relatively free access, we can distinguish those that are aimed at thinning the blood: Curantil, Cardiomagnyl, Trental or ordinary Aspirin. They are prescribed only by a specialist.

To reduce your hemoglobin level at home, you need to take a stricter approach to your diet and review your diet:

Increased fluid levels in the body. To do this, just drink more warm liquid. If this is not possible (for example, with severe extensive burns), then use droppers with saline solution.
It is recommended to reduce in the diet fats, confectionery with cream and eggs, as they increase cholesterol and so on thick blood. You should not take multivitamins or medications containing copper and iron. Give preference to seafood, white meat, legumes, nuts and vegetables.
Should limit consumption of foods that increase hemoglobin. These are foods rich in protein and iron - red meats, red fruits, vegetables and berries, meat by-products, fish caviar, butter, buckwheat porridge, sweet and smoked.

It is useful to eat the following foods:

Fish of any kind and seafood (except mussels).
Chicken meat.
Some legumes.
Fresh raw salads from vegetables and fruits.
Boiled and baked vegetables.

We have already said that increased hemoglobin is only a symptom of some disease. Therefore, simultaneously with its normalization, it is necessary to find and eliminate the primary cause.