Renal cell carcinoma can cause polycythemia through ectopic erythropoietin production. Which hematologic change does this cause?

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Ectopic erythropoietin production by a renal cell carcinoma stimulates red blood cell production in the bone marrow, leading to polycythemia. EPO acts on erythroid precursors to boost erythropoiesis, so tumor-derived EPO raises the red cell mass and hemoglobin/hematocrit levels, independent of oxygen needs. This is a classic paraneoplastic syndrome of RCC. The other options describe scenarios with reduced red cells or other cell lines, which don’t fit this mechanism: decreased EPO causing anemia, or changes in platelets or white cells are not the typical RCC paraneoplastic presentation.