Since Jenny was healthy her RBC count probably in the region of 55.0 to 5.4 million RBCs per microliter of blood The elevation of her RBC numbers and blood hemoglobin content was attributed to four months of smoking. It is quite possible that smoking created a hypoxic situation in her respiratory and circulatory system and her body responded by increasing the proliferation of RBCs and increasing the production of hemoglobin in order to improve the oxygen-carrying capacity of the blood the new low oxygen environment . The smoke of smoking as well as nicotine would damage the air ways and reduce the tidal volume of air and the amount of oxygen available at each breath Other factors Benzene which a component of tobacco would have inimical effects on bone marrow production of blood cells . In the short run this would aggravate the results of hypoxia, but it would also result in a stimulation of erythropoietin production by the liver. This would increase the hematocrit ,and RBC numbers in the short run. Changes in carbon dioxide levels would tend to shift the oxygen dissociation curve to the right. Howeve,r the Carbon monoxide would increase capillary permeability and tend to promote polycythemia.
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Cigarette smoke itself would impair respiration and create a hypoxic situation. The response of the liver would be to increase the production of erythropoietin which would stimulate the red bone marrow to produce more RBCs . This would account for the increased hematocrit. Benzene in cigarette smoke, and carbon dioxide would also contribute to impaired respiration. T he increased level of carbon monoxide would add a polycythemic effect by increasing capillary permeability and consequent dehydration.