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Raised-Haematocrit incl Polycythemia vera

This chart addresses the frequently seen problem of a raised haematocrit when reviewing haematology results. This simple visual can helps GP decide when to suspect an underlying serious disease as polycythemia vera which is a blood neoplasm.Polycythemia vera 
& Essential thrombocytosis
 are among the 
Phialdelphia chromosome negative 
neoplasms.Polycythemia vera is a
 rare disease -diagnosed 
@ 2 cases per 100,000 people –

Polycythemia vera – most deaths from ischaemic stroke and MI Life expectancy increases ( 20 yrs in average ) with treatment ( PV ) PV patients need regular haematology f/u as 2-8 % cases can transform into myelofibrosis and about 1-3 % can transform to AML People with secondary causes may have increased risk of thrombosis but this is substantially less than for people with PV

History and examination H/O smoking and thrombosis FBC JAK2 mutation testing Serum EPO ( erythropoetin ) Ferritin Renal and liver function tests Screen 
Hypertension , Cholesterol , Diabetes.Fatigue + headache + blurred vision 
+ slow ability to think Night sweats Tinnitus Bone pain Itching – particularly after bathing Erythromelalgia- burning sensation fingers/ toes Splenomegaly Weight loss Dizziness or light headedness Bruising , bleeding or clotting

True increase in in RBC-Primary bone marrow problem-Polycythemia vera ( PV) Exon 12 mutations

Secondary to other disorder eg Hypoxia-Hypoxia driven Central hypoxic process Chronic lung disease Rt to Lt cardiopulmonary vascular shunts Carbon monoxide poisoning Smokers erythrocytosis Hypoventilation syndromes including sleep apnoea Local renal hypoxia Renal artery stenosis End-stage renal disease Hydronephrosis Renal cysts- polycytic kidney disease.Pathological EPO production Tumours Hepatocellular carcinoma Renal cell cancer Cerebellar hemangioblastoma Parathyroid carcinoma/ adenomas Uterine leiomyomas Phaeochromocytoma Meningioma.Exogenous EPO Drug associated Treatment with androgen preparations Post renal transplant erythrocytosis Idiopathic erythrocytosis

Apparent polycythaemia-Raised haematocrit and Hb conc with a normal cell mass. Due to low plasma volume.Heavy smoking Heavy alcohol consumption hypertension particularly thiazide diuretic use

Common in obese men


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