An Overview of Secondary Polycythemia

An Overproduction of Red Blood Cells Caused by Health Disorders

Red blood cells, illustration

KTS Design / Science Photo Library / Getty Images

Table of Contents
View All
Table of Contents

Secondary polycythemia, similar to primary polycythemia vera, is a disorder that causes an overproduction of red blood cells. When too many red blood cells are produced, the blood becomes thick, hindering its passage through the smaller blood vessels.

The difference between the two has to do with what the disorder is associated with. Secondary polycythemia is associated with an underlying disease process, but primary polycythemia is not.

Secondary Polycythemia Symptoms

Symptoms of secondary polycythemia, which are the same as those for primary polycythemia, may include:

  • Weakness
  • Headache
  • Fatigue
  • Lightheadedness
  • Shortness of breath
  • Visual disturbances
  • Itching (pruritus)
  • Pain in the chest or leg muscles
  • Ruddy complexion
  • Confusion
  • Ringing in the ears (tinnitus)
  • Burning sensations of the hands or feet


Primary polycythemia is caused by an abnormality of the cells in the bone marrow that form red blood cells. Secondary polycythemia is caused by a disorder originating outside of the bone marrow that causes overstimulation of the normal bone marrow, leading to an overproduction of red blood cells.

The job of a red blood cell is to deliver oxygen to the body tissues. Smoking, for example, interferes with this process, so it is a common cause of secondary polycythemia. Others include:


Measuring oxygen levels in the blood with a blood test known as arterial blood gas (ABG) can help healthcare providers formulate a diagnose of secondary polycythemia. Other blood tests include measurement of erythropoietin and red blood cell mass levels.

Additional diagnostic tests include an electrocardiogram (ECG) to measure heart function and imaging tests, such as a chest X-ray, computed tomography (CT), or ultrasound, to detect the enlargement of the heart, liver, or spleen.

Your healthcare provider may also use a genetic test that looks for a mutation in a gene called JAK2 that affects the bone marrow and blood cells. This test is positive in most cases of primary polycythemia and, as a result, is used to differentiate between primary polycythemia and secondary polycythemia.


Treatment for secondary polycythemia should control or eliminate the underlying condition. Symptom relief may include medications such as antihistamines to relieve itching, or aspirin to soothe pain and burning associated with the disorder.

Because it takes the time to treat the underlying condition, healthcare providers sometimes use phlebotomy (blood-letting) to reduce the number of red blood cells in plasma. As much as a pint (475 milliliters) may be taken in one sitting as long as the individual can tolerate it.


If you're already coping with one condition that can cause secondary polycythemia, such as COPD or a tumor, learning that you have a second diagnosis to cope with is understandably frustrating. You want to feel better, not worse.

Remember that secondary polycythemia is caused by an underlying condition, most of which are well known and have multiple treatment options available. Once the underlying cause is corrected, symptoms of secondary polycythemia usually go away. Your healthcare provider will guide you along the best path for resolving both.

Polycythemia Vera Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. McMullin MFF, Mead AJ, Sahra A, et al. A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis: a British Society for Haematology guideline. Br J Haematol. 2019 Jan;184(2):161-75. doi:10.1111/bjh.15647

  2. Assi TB, Baz E. Current applications of therapeutic phlebotomy. Blood Transfus. 2014 Jan;12(Suppl 1):s75-83. doi:10.2450/2013.0299-12

By Deborah Leader, RN
 Deborah Leader RN, PHN, is a registered nurse and medical writer who focuses on COPD.