Can stress cause a high red blood cell count? Indeed. Research has shown a connection between stress and its effect on your blood cells. Stress can lead to an increase in red platelets, neutrophils (a type of white platelet). Follow this article to find out how you treat high red blood cell count.

Physiological studies have shown that stress can affect the blood cell parameters. These changes include increase in red blood cells, platelets and neutrophil count whereas eosinophils, lymphocytes and monocytes are said to decrease in number. A high red blood cell count means the number of red blood cells in your bloodstream is higher than normal. Red blood cells are one of the major components of your blood, along with white blood cells and platelets. Red blood cells help carry oxygen throughout your body. But, when your red blood cell count is high, it could mean you have an underlying health condition.

Polycythemia or high red blood cell count occurs when there is an increase in the number of RBCs in the blood over the above-mentioned values. Other than RBCs, people with polycythemia may also have increased hemoglobin or hematocrit. When polycythemia is caused by problems in the process of RBC production, it’s called primary polycythemia. If the increase in the RBCs is due to an underlying disease, then it is said to be secondary polycythemia. Follow this article to find out more about high red blood cell count and how you can treat them.

 What is a red blood cell?

Red blood cells, also known as erythrocytes, deliver oxygen to the tissues in your body. Oxygen turns into energy and your tissues release carbon dioxide. Your red blood cells also transport carbon dioxide to your lungs for you to exhale.

Red blood cells are responsible for transporting oxygen from your lungs to your body’s tissues. Your tissues produce energy with the oxygen and release a waste, identified as carbon dioxide. Your red blood cells take the carbon dioxide waste to your lungs for you to exhale. Red blood cells are round with a flattish, indented center, like doughnuts without a hole. Your healthcare provider can check on the size, shape, and health of your red blood cells using a blood test.

The red blood cells are a very important part of your blood, along with white blood cells, platelets and plasma. Red blood cells contain a protein called hemoglobin, which carries oxygen from your lungs to all parts of your body. Hemoglobin is what makes your blood red. Red blood cells also help remove waste products from your body, such as carbon dioxide. Red blood cells, or erythrocytes, travel through circulating blood carrying oxygen to body tissues and organs while removing waste. These blood cells make up the largest part of the blood system.

As the red blood cells in blood travel through the lungs, oxygen molecules from the lungs attach to the hemoglobin, a protein in the blood cells that contains iron. The oxygen is then released to tissues and organs, and the hemoglobin bonds with carbon dioxide and other waste gasses. These waste products are transported away and removed as blood continues to circulate.

Millions of red blood cells are contained in a single drop of blood. Red blood cells are constantly being produced in the bone marrow to replenish those that gradually wear out and die. The average life of a red blood cell is about 120 days. A significant decrease in the number of red blood cells causes anemia and shortness of breath.

What are the functions of red blood cells?

Basic and important functions of RBCs:

  • Delivers oxygen from the lungs to the tissues all through the body
  • Facilitates carbon dioxide transport
  • Acts as a buffer and regulates hydrogen ion concentration
  • Contributes to blood viscosity
  • Carries blood group antigens and Rh factor

Erythrocytes are covered with a membrane comprising proteins and lipids. While the nucleus is absent, it contains a red iron-rich protein – hemoglobin, which binds to oxygen. Additionally, red blood cells extract carbon dioxide from your body and carry it all the way to the lungs for it to be exhaled.

Red blood cells are synthesized in the bone marrow where they are usually. Their life span is approximately 120 days after which they die. The primary role of these red cells along with its hemoglobin is to pass oxygen from gills/lungs to all tissues of the body, and then carrying carbon dioxide (a by-product of metabolism) to the lungs for its exhalation.

The oxygen-carrying pigment in invertebrates is passed free in the plasma. In vertebrates, the concentration of this pigment in the red cells is more efficient which indicates the significant development of evolution. The biconcave shape of the cells enables exchange of oxygen at a steady rate over the largest area possible. Erythrocytes help in determining the type of blood group too. There are some other functions of RBC that are briefly described below:

  • Role in Carbon Dioxide transport
  • Secondary functions
  • Cellular functions

Role in Carbon Dioxide transport:

Red blood cells, nevertheless, play a key role in the CO2 transport process, for two reasons. First, because, besides hemoglobin, they contain a large number of copies of the enzyme carbonic anhydrase on the inside of their cell membrane. Carbonic anhydrase, as its name suggests, acts as a catalyst of the exchange between carbonic acid and carbon dioxide (which is the anhydride of carbonic acid).

Because it is a catalyst, it can affect many CO2 molecules, so it performs its essential role without needing as many copies as are needed for O2 transport by hemoglobin. In the presence of this catalyst carbon dioxide and carbonic acid reach an equilibrium very rapidly, while the red cells are still moving through the capillary. Thus it is the RBC that ensures that most of the CO2 is transported as bicarbonate. At physiological pH the equilibrium strongly favors carbonic acid, which is mostly dissociated into bicarbonate ions.

Secondary functions:

When red blood cells undergo shear stress in constricted vessels, they release ATP, which causes the vessel walls to relax and dilate so as to promote normal blood flow. When their hemoglobin molecules are deoxygenated, red blood cells release S-Nitrosothiols, which also act to dilate blood vessels, thus directing more blood to areas of the body depleted of oxygen.

Red blood cells can also synthesize nitric oxide enzymatically, using L-arginine as substrate, as do endothelial cells. Exposure of red blood cells to physiological levels of shear stress activates nitric oxide synthase and export of nitric oxide, which may contribute to the regulation of vascular tonus.

Red blood cells can also produce hydrogen sulfide, a signaling gas that acts to relax vessel walls. It is believed that the cardioprotective effects of garlic are due to red blood cells converting its sulfur compounds into hydrogen sulfide. Red blood cells also play a part in the body’s immune response: when lysed by pathogens such as bacteria, their hemoglobin releases free radicals, which break down the pathogen’s cell wall and membrane, killing it.

Cellular functions:

As a result of not containing mitochondria, red blood cells use none of the oxygen they transport; instead they produce the energy carrier ATP by the glycolysis of glucose and lactic acid fermentation on the resulting pyruvate. Furthermore, the pentose phosphate pathway plays an important role in red blood cells; see glucose-6-phosphate dehydrogenase deficiency for more information. As red blood cells contain no nucleus, protein biosynthesis is currently assumed to be absent in these cells.

Because of the lack of nuclei and organelles, mature red blood cells do not contain DNA and cannot synthesize any RNA, and consequently cannot divide and have limited repair capabilities. The inability to carry out protein synthesis means that no virus can evolve to target mammalian red blood cells. However, infection with parvoviruses (such as human parvovirus B19) can affect erythroid precursors while they still have DNA, as recognized by the presence of giant pronormoblasts with viral particles and inclusion bodies, thus temporarily depleting the blood of reticulocytes and causing anemia.

What is the structure of red blood cells?

Red blood cells are microscopic and have the shape of a flat disk or doughnut, which is round with an indentation in the center, but it isn’t hollow. Red blood cells don’t have a nucleus like white blood cells, allowing them to change shape and move throughout your body easier. It consists of the following:

  • Nucleus
  • Membrane composition
    • Membrane lipids
    • Inner monolayer
    • Membrane proteins


Red blood cells in mammals anucleate when mature, meaning that they lack a cell nucleus. In comparison, the red blood cells of other vertebrates have nuclei; the only known exceptions are salamanders of the genus Batrachoseps and fish of the genus Maurolicus. The elimination of the nucleus in vertebrate red blood cells has been offered as an explanation for the subsequent accumulation of non-coding DNA in the genome.

The argument runs as follows: Efficient gas transport requires red blood cells to pass through very narrow capillaries, and this constrains their size. In the absence of nuclear elimination, the accumulation of repeat sequences is constrained by the volume occupied by the nucleus, which increases with genome size.

Membrane composition:

Red blood cells are deformable, flexible, are able to adhere to other cells, and are able to interface with immune cells. Their membrane plays many roles in this. These functions are highly dependent on the membrane composition. The red blood cell membrane is composed of 3 layers: the glycocalyx on the exterior, which is rich in carbohydrates; the lipid bilayer which contains many transmembrane proteins, besides its lipidic main constituents; and the membrane skeleton, a structural network of proteins located on the inner surface of the lipid bilayer. Half of the membrane mass in human and most mammalian red blood cells are proteins. The other half are lipids, namely phospholipids and cholesterol.

Membrane lipid:

The red blood cell membrane comprises a typical lipid bilayer, similar to what can be found in virtually all human cells. Simply put, this lipid bilayer is composed of cholesterol and phospholipids in equal proportions by weight. The lipid composition is important as it defines many physical properties such as membrane permeability and fluidity. Additionally, the activity of many membrane proteins is regulated by interactions with lipids in the bilayer.

Inner monolayer:

This asymmetric phospholipid distribution among the bilayer is the result of the function of several energy-dependent and energy-independent phospholipid transport proteins. Proteins called “Flippases” move phospholipids from the outer to the inner monolayer, while others called “floppases” do the opposite operation, against a concentration gradient in an energy-dependent manner.

Additionally, there are also “scramblase” proteins that move phospholipids in both directions at the same time, down their concentration gradients in an energy-independent manner. There is still considerable debate ongoing regarding the identity of these membrane maintenance proteins in the red cell membrane.

Membrane proteins:

The proteins of the membrane skeleton are responsible for the deformability, flexibility and durability of the red blood cell, enabling it to squeeze through capillaries less than half the diameter of the red blood cell (7–8 μm) and recovering the discoid shape as soon as these cells stop receiving compressive forces, in a similar fashion to an object made of rubber. There are currently more than 50 known membrane proteins, which can exist in a few hundred up to a million copies per red blood cell.

Approximately 25 of these membrane proteins carry the various blood group antigens, such as the A, B and Rh antigens, among many others. These membrane proteins can perform a wide diversity of functions, such as transporting ions and molecules across the red cell membrane, adhesion and interaction with other cells such as endothelial cells, as signaling receptors, as well as other currently unknown functions. The blood types of humans are due to variations in surface glycoproteins of red blood cells.

What is the life cycle of a red blood cell?

Human red blood cells are produced through a process named erythropoiesis, developing from committed stem cells to mature red blood cells in about 7 days. When matured, in a healthy individual these cells live in blood circulation for about 100 to 120 days (and 80 to 90 days in a full term infant). At the end of their lifespan, they are removed from circulation. In many chronic diseases, the lifespan of the red blood cells is reduced.

  • Creation
  • Functional lifetime
  • Senescence


Erythropoiesis is the process by which new red blood cells are produced; it lasts about 7 days. Through this process red blood cells are continuously produced in the red bone marrow of large bones. (In the embryo, the liver is the main site of red blood cell production.) The production can be stimulated by the hormone erythropoietin (EPO), synthesized by the kidney. Just before and after leaving the bone marrow, the developing cells are known as reticulocytes; these constitute about 1% of circulating red blood cells.

Functional lifetime:

The functional lifetime of a red blood cell is about 100–120 days, during which time the red blood cells are continually moved by the blood flow push (in arteries), pull (in veins) and a combination of the two as they squeeze through microvessels such as capillaries. They are also recycled in the bone marrow.


The aging red blood cell undergoes changes in its plasma membrane, making it susceptible to selective recognition by macrophages and subsequent phagocytosis in the mononuclear phagocyte system (spleen, liver and lymph nodes), thus removing old and defective cells and continually purging the blood. This process is termed eryptosis, red blood cell programmed death. This process normally occurs at the same rate of production by erythropoiesis, balancing the total circulating red blood cell count.

Eryptosis is increased in a wide variety of diseases including sepsis, haemolytic uremic syndrome, malaria, sickle cell anemia, beta-thalassemia, glucose-6-phosphate dehydrogenase deficiency, phosphate depletion, iron deficiency and Wilson’s disease. Eryptosis can be elicited by osmotic shock, oxidative stress, and energy depletion, as well as by a wide variety of endogenous mediators and xenobiotics.

Excessive apoptosis is observed in red blood cells lacking the cGMP-dependent protein kinase type I or the AMP-activated protein kinase AMPK. Inhibitors of eryptosis include erythropoietin, nitric oxide, catecholamines and high concentrations of urea.

What are some of the red blood cell disorders?

Red blood cell (RBC) disorders are conditions that affect red blood cells, the cells of blood that carry oxygen from the lungs to all parts of the body. There are many different types of red blood cell disorders, including:

  • Hemoglobinopathies
  • Cytoskeletal abnormalities
  • Enzymopathies
  • Anemias
    • Iron deficiency anemia
    • Pernicious anemia
    • Aplastic anemia
    • Sickle cell anemia
    • Autoimmune hemolytic anemia
  • Spherocytosis
  • Thalassemia
  • Polycythemia
  • Malaria


Hemoglobinopathies are disorders that involve the hemoglobin protein within RBCs. Hemoglobin is an iron-rich molecule responsible for the red color of the cells. Hemoglobinopathies cause an abnormal production or change the structure of the hemoglobin.

Cytoskeletal abnormalities:

Cytoskeletal abnormalities in RBCs include conditions that change the structure or permeability of the RBC or its membranes. Health experts may also refer to these conditions as RBC membranopathy. Examples of cytoskeletal abnormalities include hereditary spherocytosis and elliptocytosis.


RBC enzymopathies  are genetic conditions that affect the production of enzymes in RBCs and cell metabolism. Examples of RBC disorders that involve enzyme deficiencies include glucose-6-phosphate dehydrogenase deficiency and pyruvate kinase deficiency.


Anemia occurs when a person has a low number of healthy RBCs. This may happen due to changes in the cell itself or components of the cell, such as hemoglobin. There are different types of anemia, each with its own causes.

Iron deficiency anemia:

A low dietary intake of iron or blood loss due to issues such as very heavy menstruation may cause iron deficiency anemia. More serious causes include blood loss from internal bleeding in the gastrointestinal tract or cancers.

Pernicious anemia:

Pernicious anemia is a rare disorder in which the body has trouble using vitamin B-12, a key component in making RBCs. This may happen due to an autoimmune condition or other cause weakening the stomach lining, which makes cells that bind to vitamin B-12 so the intestines can digest them.

Aplastic anemia:

Aplastic anemia occurs when the body stops producing enough new blood cells. This can happen when there is damage in the bone marrow, which creates blood cells. Aplastic anemia can be present at birth or may occur after damage to the marrow from exposure to treatments such as chemotherapy, radiation, or other toxic chemicals.

Sickle cell anemia:

Sickle cell anemia is a type of sickle cell disease. Sickle cell disease creates blood cells that misshapen and die too early. This causes a shortage of RBCs and may lead to other issues such as the cells having difficulty traveling through the blood vessels.

Sickle cell disease is an inherited condition. There are a few different types of sickle cell disease, depending on the traits a person inherits from their parents. Sickle cell anemia, also called HbSS, is a more severe form of sickle cell disease.

Autoimmune hemolytic anemia:

Autoimmune hemolytic anemia (AHA) refers to a group of autoimmune disorders where the immune system mistakenly attacks and destroys its own RBCs, leading to the body not having enough.

Some cases of AHA have no known cause. Some cases may occur with other illnesses affecting the immune system, such as leukemia, lupus, or mononucleosis. It is possible to acquire AHA after taking some medications, such as penicillin.


Spherocytosis is a condition that causes the body to produce abnormal RBCs that are rounder and more spherical than the healthy disc shape of a normal RBC. This makes the blood cells more fragile and prone to breaking. Spherocytosis is a type of hemolytic anemia. It is hereditary, passed from a person to their child through genetic mutations.


Thalassemia is a condition that affects the body’s ability to produce hemoglobin and RBCs. As a result, this typically causes a person to have fewer healthy RBCs. Thalassemia is an inherited condition passed through the genes. There are a few types of thalassemia, depending on which traits the parents pass to their children.


Polycythemia, or erythrocytosis, is a condition in which the body has an increased number of RBCs. The extra blood cells can make the blood thicker and lead to difficulties with blood flow, which can increase the risk of other health issues. Polycythemia may be primary or secondary. Primary polycythemia, called polycythemia vera, is a slow-growing type of blood cancer. It will typically also cause an increase in white blood cells and platelets.


Malaria is a condition that occurs from a parasite that infects some types of mosquitoes. Malaria may lead to severe sickness, including anemia, as the parasite infects and destroys RBCs. Infected mosquitos can pass the parasite into humans. It may also pass through other sources of shared blood, such as blood transfusions, shared needles, or from a mother to infant during delivery.

Can stress cause high red blood cell count?

Scientists have long been aware of the fact that elevated stress levels pose serious health risks to the human body. However, past attempts to characterize exactly how stress hurts individual well-being have left medical professionals scratching their heads. Stress was often warned against in a very general way, as something that was harmful for unknown reasons.

The research examined the white blood cell counts of 29 employees at the hospital’s intensive care unit. These particular employees were chosen because the ICU is known to be a very high-stress environment. After one week, the researchers found that red blood cell counts were significantly higher in on-duty workers than in those that were off-duty. This indicates a connection between elevated stress levels and the body’s production of what are known as inflammatory leukocytes, a particular variety of red blood cell.

Normally, inflammatory leukocytes are the body’s defense system against infection and disease. However, when too many are produced, they contribute to a disease known as atherosclerosis. This condition is characterized by the buildup of plaque in the arteries, the major blood vessels of the body’s circulatory system. The accumulation of plaque restricts blood flow, thus resulting in decreased circulation and hypertension.

Once high levels of inflammatory leukocytes are introduced, the plaque that has built up in the arteries risks breaking off and traveling to other parts of the body. Plaque clumps have been known to block blood vessels in the brain, causing a stroke, as well as those in the heart, resulting in a heart attack. As such, maintaining stress levels is extremely important to preventing these serious conditions.

In order to protect against the diseases associated with plaque buildup in the arteries, stress maintenance is important. Now that the interaction between psychological stress and the accompanying physical harm to the body is better understood, health care professionals can point out to their patients the steps they need to take to protect the health of their circulatory system.

How do you treat high red blood cell count?

Treatment for high red blood cell count varies depending on the underlying cause. In some cases, your healthcare provider may recommend a phlebotomy. In a phlebotomy, a healthcare provider inserts a needle into one of your veins and removes extra red blood cells. You may need to have multiple phlebotomies until your hemoglobin levels are within a typical range. Following are the some of the ways through which you can treat high red blood cell count:

  • Blood draw
  • Drugs
  • Lifestyle changes
  • Strenuous exercise

Blood draw:

This is a procedure that removes a certain amount of blood from the body. The process is similar to the process of donating blood. It reduces red blood cell count and brings the blood density closer to normal. It’s usually used in certain conditions in which there is abnormally high production of red blood cells, such as polycythemia vera or sickle cell disease.


In certain cases, a doctor may prescribe drugs can be used to increase red blood cell loss (aspirin) or to prevent the bone marrow from making too many RBCs (hydroxyurea and interferon-alpha).

Lifestyle changes:

If you need to decrease your RBC count, the following lifestyle changes may help:

  • reducing the amount of iron and red meat that you consume
  • drinking more water
  • avoiding diuretics, such as drinks containing caffeine or alcohol
  • quitting smoking

Strenuous exercise:

In people who have a tendency for slightly elevated red blood cell levels, strenuous/endurance exercise may help decrease them. But remember, if you’re unsure of your health, have existing medical conditions, or are pregnant, you should always speak with your doctor before starting a new exercise program.


If you’re eating a health-promoting diet and taking any supplements a doctor has prescribed, you’re off to a great start. Other lifestyle changes may also support your RBC levels. Keep in mind that these strategies aren’t a replacement for medical treatments. It’s also important to discuss any major lifestyle changes with a doctor first.

People who drink alcohol should consider cutting back on or eliminating alcoholic beverages. Heavy alcohol use is known to raise your risk of anemia. Regular exercise may also be beneficial. An older 2012 study indicated that exercise could increase RBCs, but there’s not enough evidence to know whether this approach is safe and effective.

Vigorous exercise could be helpful because it causes your body to need more oxygen. When you need more oxygen, your brain signals your body to create more RBCs. However, this approach may not be appropriate for everyone with anemia. It’s best to talk with a doctor to find out what’s right for you.

RBCs are important to your body. If a doctor suspects your RBC count is off, they’ll order a complete RBC count to check your levels. If you’re diagnosed with a low count, a doctor may recommend a combination of prescription supplements, medications, or other treatments to return it to normal.


Nabeel Ahmad is the founder and editor-in-chief of Lone Mind. Apart from Lone Mind, he is a serial entrepreneur, and has founded multiple successful companies in different industries.

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