{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:42:53Z","timestamp":1756384973482,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Water-pipe (shisha) smoking is increasingly popular among young people in Europe and North America. The proponents claim that smoking water-pipe is much \u2018cleaner\u2019 than cigarettes. Although, a recent analysis of toxicant yields during 1\u20132\u2005h water-pipe smoking resulted comparable to 100\u2013200 cigarettes. We report a case of a 25-year-old patient with elevated haemoglobin, impaired concentration and reduced physical performance. Molecular investigations for JAK2 mutations and BCR\u2013ABL fusion transcripts were negative and the arterial blood gas analysis revealed an elevated carboxyhaemoglobin of 6.1%. In a follow-up visit, the patient disclosed excessive shisha smoking. Secondary polycythaemia was diagnosed caused by chronic carbon monoxide poisoning. After cessation of shisha smoking all blood values returned to normal ranges within 6\u2005weeks. Owing to the increasing popularity of water-pipe smoking and the anticipated health risks, our report should help to enhance awareness and advocate more information in tobacco prevention programmes on its potential toxicities.<\/jats:p>","DOI":"10.1136\/bcr-2013-200665","type":"journal-article","created":{"date-parts":[[2013,10,18]],"date-time":"2013-10-18T10:32:53Z","timestamp":1382092373000},"page":"bcr2013200665","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["When water does not clear the smut from the smoke"],"prefix":"10.1136","volume":"2013","author":[{"given":"Nicolas","family":"Bonadies","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Haematology, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9","family":"Tichelli","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Rov\u00f3","sequence":"additional","affiliation":[{"name":"Department of Haematology, University Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,10,18]]},"reference":[{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.addbeh.2010.08.030","article-title":"The global epidemic of waterpipe smoking","volume":"2013","author":"Maziak","year":"2011","journal-title":"Addict Behav"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.5993\/AJHB.34.3.3","article-title":"Waterpipe tobacco smoking: an emerging health crisis in the United States","volume":"2013","author":"Cobb","year":"2010","journal-title":"Am J Health Behav"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.3","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1158\/1055-9965.EPI-11-0586","article-title":"Significance of smoking machine toxicant yields to blood-level exposure in water pipe tobacco smokers","volume":"2013","author":"Shihadeh","year":"2011","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/ntr\/ntq212","article-title":"Waterpipe tobacco smoking and cigarette smoking: a direct comparison of toxicant exposure and subjective effects","volume":"2013","author":"Cobb","year":"2011","journal-title":"Nicotine Tob Res"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.5","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2310\/8000.2011.110431","article-title":"Carbon monoxide poisoning in narghile (water pipe) tobacco smokers","volume":"2013","author":"La Fauci","year":"2012","journal-title":"CJEM"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.6","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1158\/1055-9965.EPI-12-1422","article-title":"Comparison of nicotine and carcinogen exposure with water pipe and cigarette smoking","volume":"2013","author":"Jacob","year":"2013","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.7","doi-asserted-by":"crossref","first-page":"5104","DOI":"10.1182\/blood-2006-12-038968","article-title":"How I treat patients with polycythemia vera","volume":"2013","author":"Finazzi","year":"2007","journal-title":"Blood"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.8","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1056\/NEJM197801052980102","article-title":"Smokers\u2019 polycythemia","volume":"2013","author":"Smith","year":"1978","journal-title":"N Engl J Med"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.9","first-page":"311","article-title":"How carbon monoxide reduces plasma volume","volume":"2013","author":"Stonesifer","year":"1978","journal-title":"N Engl J Med"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.10","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/00007611-198002000-00005","article-title":"Erythrocytosis associated with carboxyhemoglobinemia in smokers","volume":"2013","author":"McAloon","year":"1980","journal-title":"South Med J"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.11","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1164\/rccm.201207-1284CI","article-title":"Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning","volume":"2013","author":"Hampson","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"2025082805102621000_2013.oct18_1.bcr2013200665.12","doi-asserted-by":"crossref","unstructured":"Karaca Y Eryigit U Aksut N . Syncope associated with water pipe smoking. BMJ Case Rep. 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