Polycythemia refers to an increased red blood cell count. It can be absolute, meaning the actual number of red blood cells is increased, or relative, where the concentration of red blood cells is increased but the total number is normal. Absolute polycythemia includes primary polycythemia vera, a malignant stem cell disorder causing overproduction of red and other blood cells. It presents with headaches, fatigue, and enlarged spleen and liver and risks of blood clots and bleeding. Relative polycythemia is usually due to dehydration or other causes of plasma volume decrease, not an increased red blood cell count.