Hookah Smokers, Beware!! Severe Erythrocytosis noted in Hookah Smokers: A Case Series of 13 Patients

Over the past decade, hookah smoking has become a popular way of smoking tobacco around the world. In this study, we explore the relationship between hookah smoking and erythrocytosis, a frequently encountered problem in Hematology clinics. Cawkwell et al. analyzed internet trends as a measure of population behaviour and revealed that New York is experiencing tremendous growth in hookah bars with an overwhelming majority located in New York City. As hookah smoking is not considered a traditional form of smoking, patients can often neglect this information when asked about their smoking history. We did a retrospective chart review of 13 patients with otherwise unexplained erythrocytosis and a history of hookah smoking. Our results showed the median age of the study group was 33 years (range, 22-60) and mean hemoglobin level was 19.16 g/dL. JAK2 mutation was negative and erythropoietin level was normal to high in all patients. No correlation was found between the intensity of hookah smoking and degree of erythrocytosis (Pearson correlation factor was -0.139). There is a popular belief that smoking tobacco through a hookah pipe is harmless however, studies showed that smoke from a hookah pipe can be equally dangerous to cigarette smoke and contains various toxicants that can cause a myriad of health problems. Our study showed that hookah smoking can cause significant erythrocytosis and should be considered as a possible etiology in the evaluation of unexplained erythrocytosis, especially in a young patient.