Polycythemia

Background

• AKA erythrocytosis
• Refers to abnormally elevated Hb/Hct

Clinical Features

• Dependant on underlying etiology
• May be entirely asymptomatic
• Possible features include plethora, tendency towards thromboembolism or bleeding, splenomegaly, pruritus

Differential Diagnosis

• Primary polycythemia (myeloproliferative disorders)
  • Polycythemia vera
  • Essential thrombocytosis (ET
  • Chronic myelogenous leukemia (CML)
  • Leukemoid Reaction
  • Myelofibrosis
• Secondary polycythemia (due to increased EPO)
  • Chronic hypoxemia (e.g. COPD, physiologic altitude adaptations or chronic mountain sickness)
  • Carboxyhemoglobin (chronic smokers)
  • Renal cyst or hydronephrosis
  • EPO-secreting tumors (RCC, hepatocellular carcinoma
  • Anabolic steroid abuse
  • Abnormal hemoglobins

Evaluation

• CBC
  • Hb >17.5 (males) or >15.5 (females)
• Evaluate for underlying disease

Management

• Treat underlying pathology

See also

• Polycythemia vera
• Myeloproliferative disorders