High hematocrit suggests erythrocytosis or hemoconcentration.
Dehydration is a common transient cause. Athletes may also have elevated hematocrit due to increased red blood cell mass from training at high altitudes.
Chronic causes include polycythemia vera, chronic hypoxia (for example COPD, sleep apnea, smoking, high altitude, or cyanotic congenital heart disease), testosterone therapy, and excess erythropoietin production such as from renal disease or EPO-secreting tumors.
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