Surumi ARa, Sasidharan PKb
a. Junior Resient Medicine, PVS Hospital Kozhikode;
b. Former HOD General Medicine and Division of Haematology, Govt Medical College, Kozhikode*
ABSTRACT
Introduction: Polycythaemia is an increase in the absolute red blood cell (RBC) mass with increase in haemoglobin levels and haematocrit. It can be primary and secondary. Management depends on the causes and can be pharmacological and non-pharmacological. This original study has documented polycythaemia as yet another lifestyle disease along with hypertension, diabetes, dyslipidaemia fatty liver disease
Objectives of the study: To determine the clinical profile of patients with all types polycythaemia and to study the impact of weight reduction with diet and lifestyle changes on behaviour of polycythaemias.
Methods: We enrolled 92 consecutive subjects in a tertiary care centre with confirmed polycythaemia during a period of one year, subjected them to diet and lifestyle changes with an intention to achieve weight reduction and they were followed up for six months to one year. It was a hospital based prospective study between January 2020 to June 2021. Patients who were confirmed to have polycythaemia by symptoms, signs and laboratory features were included. They were classified into primary or secondary polycythaemia based on clinical judgement and laboratory parameters. Polycythaemia vera was diagnosed using WHO 2016 criteria.1 The enrolled patients in both the groups were given clear advice on proper balanced diet with less carbohydrates and lifestyle modification aimed at weight reduction, if they were overweight, cessation of smoking and alcohol along with the standard care. They were then followed up by monthly reviews for re-counselling for lifestyle changes and weight recording at each visit with follow up for a minimum period of six months to maximum of one year. Only those who were compliant with the lifestyle changes and or achieved weight reduction were taken for the final evaluation in the study. Variables were compared between the two groups.
Results: The majority were males (88%), and the mean (SD) age was 46.5 (13.3) years. All subjects, irrespective of the causes of polycythaemia, had change in wellbeing, symptom relief, reduced frequency of venesections, haematocrit levels and other blood parameters (p value <0.05). There was statistically significant differences between the primary and the secondary polycythaemia groups, with respect to the clinical features, comorbidities, addictions and haematological profiles (p-value <0.05). The most striking observation of the study was that, there were 22 patients out of 92 (24%) with secondary polycythaemia due to overweight or obesity and they all had reversal of polycythaemia after weight reduction.
Conclusions: The study showed that intervention by diet and lifestyle modification leading to weight reduction, can reverse secondary polycythaemia due to weight gain and obesity. Besides that the same interventions, irrespective of the cause, gave statistically significant changes in haematological outcomes of all subjects with primary and secondary polycythaemia. The weight reduction needed to get benefit varied between patients but the mean weight reduction achieved was 9.13 Kg.2