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Hemoglobin slightly above - unfit to fly?

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Hemoglobin slightly above - unfit to fly?

Old 8th May 2021, 10:52
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Join Date: Aug 2013
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Hemoglobin slightly above - unfit to fly?

Hi all,

slightly lenghty post🙂

I work professionally in single pilot operations and have held Easa class 1 for 3 years and Australian class 1 for 4 years prior. In all those years my hemaglobin levels were always around upper norm and varies from 155 to167 (the norm is 160). Never got any comments from any of the AME.

Half a year ago I had to do another type of medical to join government flying organisation. I passed and was approved. However from hematologist commented that I have slightly thick blood probably due to exercise (i like jogging) and not enough drinking water (167 hemaglobin and hematorcit just above the limit). That was the end of it. Government medical commision didnt say anything and accepted without further comments)

Now I have to do two different medical evaluations yearly (great &#128578...

So the thing is now I have upcoming easa class 1 renewal and decided to open up my medical history online. Turns out that the hematologist put a diagnosis due to my slightly higher blood numbers - “secondary polycythemia”. I have called him and asked what is this and what does it means. He commented along the lines “nothing to worry about since it is just above limit, just drink more water and your numbers should be normal”. Turns out that anything that is above normal range (160) is considered “polycythemia” and there isnt any buffer zone.

Now when i open easa medical guidelines it says that applicant with “polycythemia” should be deemed unfit for flying and only after further evaluation can be issued class 1 with oml (which would obviously be the end of my career since i fly single pilot ops).

Now I am worried that despite my blood hemoglobin levels being fine for the AME all these years, because of this entry by hematologist I might lose my medical..

any advice?
Bohh is offline  
Old 8th May 2021, 12:42
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You’ve probably already done so but in case you haven’t, I wou do contact a Dr that is specialized in sports physiology as your “affliction” should be common in athletes.
They may offer a workable solution.
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Old 8th May 2021, 20:45
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Polycythaemia is a form of blood cancer. The haemaglobin or blood count is raised but a lot more. Patients may be short of breath or fatigued, have nose bleeds and many other symptoms. Their spleen may be enlarged. The next test is a full blood count looking at the various cells and then a bone marrow.

You seem to have a high haemaglobin. There are several reasons including living at altitude but the commonest is dehydration which is quite common if an individual is coming for an examination. My understanding is that the UK CAA allow a maximum haemaglobin of 180 with no problem to allow for this - I would expect a healthy adult to be 130 - 145. In other words the CAA doesnt even bother until the result is well up

On the face of it 167 is nothing to worry about either for your medical or your general health. Many doctors would not call it polycythaemia You could try drinking lots of water before your next test but this advice is just so you can see your 'normal'. Obviously if you have other symptoms, see your normal doctor.
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Old 9th May 2021, 04:06
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From a purely arithmetical perspective, some limits I found on old result sheets

135 - 175 (2020) - general doctor's lab, EU
130 - 175 (2018) - CAAC Beijing
135 - 175 (2010) - general doctor's lab, EU
130 - 170 (2006) - EASA AMC on-premises lab at CEE

The mid-range (which may or may not be the ideal) is 153 and 167 as reported is well below the upper limit. My personal results come between 148-157 with a median of 155 over the last 15 years.

The public EASA guidance does not go into the detail you describe, https://www.easa.europa.eu/sites/def...quirements.pdf. Section AMC1 and AMC2 MED.B.030 Haematology.

Contrary to the post above, 130 seems to be clearly on the low edge.

Last edited by FlightDetent; 9th May 2021 at 08:04.
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Old 9th May 2021, 06:49
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Thank you for your answers, feel bit more reassured 🙂
So what does exactly the guidance material mean by “polycythemia” (i believe in newer edition its called erythrocytosis). Is it reserved for the primary polycythemia, which like Radgirl clarified is a blood cancer?
what is then the upper limit of hemaglobin and hematocrit that will get you in trouble and require more tests? Or does it wary by country and there is no universal easa guidance?
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Old 10th May 2021, 08:54
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Google tells me the UK CAA allows up to 180. ie 180 is a pass. I suspect over 180 will lead to a full blood count. If that is normal you may pass. I have to say the top limit of 180 is very high (dont tell the CAA!!). I cant recall seeing this in any patient who is not unwell. So I really wouldnt worry about definitions or further testa


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