Long Term Exposure to Low Oxygen Levels: Smoker’s Polycythemia

Smoking with prolonged exposure to low oxygen levels is a common risk factor for cardiovascular diseases and other health problems. Long term exposure to low oxygen levels leads to increase erythropoietin production that in turn increases red blood cell mass and decreases plasma volume which can elevate blood viscosity, impairing blood flow, making individuals susceptible to vaso-occlusive events. Smoking that results in secondary polycythemia and erythrocytosis can cause additional harm in smokers. This mini-review article attempts to understand the strong association between smoking and erythrocythemia as a cause of cardiovascular disease. Polycythemia in smokers can be defined by an expansion of red cell mass with elevated haemoglobin and hematocrit as a physiologic response to increased erythropoietin production secondary to generalized tissue hypoxia. Hypoxia in smokers’ polycythemia is present with normal or falsely elevated oxygen saturation value. In addition, this article focuses on the importance of being aware of cardiovascular risk in patients with polycythemia due to chronic smoking exposure.