A 32 year old high altitude mountaineer is observed to have a hematocrit of 70%. Which of the following represents the most likely cause/explanation
**Core Concept**
Polycythemia is a condition characterized by an increased red blood cell mass, often caused by increased erythropoietin production in response to hypoxia. At high altitudes, the lower oxygen levels trigger a compensatory increase in red blood cell production to improve oxygen delivery to tissues.
**Why the Correct Answer is Right**
At high altitudes, the partial pressure of oxygen (pO2) in the blood is lower, triggering the release of erythropoietin (EPO) from the kidneys. EPO stimulates the bone marrow to produce more red blood cells, leading to an increase in hematocrit. In this case, the hematocrit of 70% is significantly elevated, indicating polycythemia secondary to chronic hypoxia. The increased red blood cell mass helps to compensate for the lower oxygen levels at high altitudes, improving oxygen delivery to tissues.
**Why Each Wrong Option is Incorrect**
**Option A:** Dehydration would cause a decrease in plasma volume, not an increase in hematocrit. Dehydration would lead to a relative increase in red blood cell concentration, but it's not the primary cause of polycythemia in this scenario.
**Option B:** Sickle cell disease is a genetic disorder that affects hemoglobin production, but it's not directly related to high altitude exposure.
**Option C:** Hematological malignancies, such as myeloproliferative neoplasms, can cause polycythemia, but they are not the most likely explanation in this case, given the patient's history of high altitude mountaineering.
**Clinical Pearl / High-Yield Fact**
Polycythemia secondary to high altitude exposure can increase the risk of thrombotic events, such as deep vein thrombosis and pulmonary embolism, due to the increased blood viscosity and clotting tendency.
**Correct Answer: C.**