Polycythemia vera differential diagnosis: Difference between revisions
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! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |PT/PTT | ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |PT/PTT | ||
|- | |- | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |JAK2 mutation | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CALR mutation | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CALR mutation | ||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue | ||
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|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Polycythemia vera (PV)]] | ! align="center" style="background:#DCDCDC;" |[[Polycythemia vera (PV)]] | ||
|> 95% | | align="center" style="background:#F5F5F5;" |> 95% | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" |Autonomous erythrocyte production | ||
| align="center" style="background:#F5F5F5;" | | |||
| | | align="center" style="background:#F5F5F5;" |+ | ||
| + | | align="center" style="background:#F5F5F5;" |- | ||
| - | | align="left" style="background:#F5F5F5;" | | ||
| | |||
* [[Erythromelagia]] | * [[Erythromelagia]] | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* [[Stroke]]-like symptoms | * [[Stroke]]-like symptoms | ||
|[[Ruddy face]] | | align="center" style="background:#F5F5F5;" |[[Ruddy face]] | ||
| - | | align="center" style="background:#F5F5F5;" | - | ||
| - | | align="center" style="background:#F5F5F5;" | - | ||
| + | | align="center" style="background:#F5F5F5;" | + | ||
|NA | | align="center" style="background:#F5F5F5;" |NA | ||
|↑ | | align="center" style="background:#F5F5F5;" |↑ | ||
|↑ RBC mass | | align="center" style="background:#F5F5F5;" |↑ RBC mass | ||
|Nl to ↑ | | align="center" style="background:#F5F5F5;" |Nl to ↑ | ||
|Nl to ↑ | | align="center" style="background:#F5F5F5;" |Nl to ↑ | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* [[Aspirin]] | * [[Aspirin]] | ||
* [[Ruxolitinib]] | * [[Ruxolitinib]] | ||
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* [[Phlebotomy]] | * [[Phlebotomy]] | ||
* [[Interferon-alpha]] | * [[Interferon-alpha]] | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* [[Stroke]] | * [[Stroke]] | ||
* [[Venous thrombosis]] | * [[Venous thrombosis]] | ||
* Myelofibrosis | * [[Myelofibrosis]] | ||
* Acute leukemia | * [[Acute leukemia]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Essential thrombocythemia]] (ET) | ! align="center" style="background:#DCDCDC;" |[[Essential thrombocythemia]] (ET) | ||
|50% | | align="center" style="background:#F5F5F5;" |50% | ||
| +/- | | align="center" style="background:#F5F5F5;" |+/- | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* Clonal proliferation of megakaryocytes | * Clonal proliferation of megakaryocytes | ||
* Excess [[platelet]] production | * Excess [[platelet]] production | ||
| + | | align="center" style="background:#F5F5F5;" | + | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| + (paradoxical) | | align="center" style="background:#F5F5F5;" |+ (paradoxical) | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* Stroke-like symptoms | * Stroke-like symptoms | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| + | | align="center" style="background:#F5F5F5;" |+ | ||
|Bruises | | align="center" style="background:#F5F5F5;" |[[Bruises]] | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
|↑ (dysfunctional platelets) | | align="center" style="background:#F5F5F5;" |↑ (dysfunctional platelets) | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="center" style="background:#F5F5F5;" | | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* [[Aspirin]] | * [[Aspirin]] | ||
* [[Hydroyurea]] | * [[Hydroyurea]] | ||
* [[Anagrelide]] | * [[Anagrelide]] | ||
| | | align="left" style="background:#F5F5F5;" | | ||
* Acquired von Willebrand disease | * Acquired [[von Willebrand disease]] | ||
* Myelofibrosis | * [[Myelofibrosis]] | ||
* Acute leukemia | * [[Acute leukemia]] | ||
|- | |- | ||
! align="center" style="background:#DCDCDC;" |[[Chronic myeloid leukemia]] (CML) | ! align="center" style="background:#DCDCDC;" |[[Chronic myeloid leukemia]] (CML) |
Revision as of 17:31, 20 August 2018
Polycythemia vera Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Polycythemia vera differential diagnosis On the Web |
American Roentgen Ray Society Images of Polycythemia vera differential diagnosis |
Risk calculators and risk factors for Polycythemia vera differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]; Shyam Patel [3]
Overview
Polycythemia vera must be differentiated from other myeloproliferative neoplasms, such as chronic myelogenous leukemia, essential thrombocythemia, and primary myelofibrosis. Polycythemia vera must also be differentiated from secondary polycythemia, which is usually due to chronic hypoxia. Each of these conditions have different etiologies, symptoms, laboratory abnormalities, physical exam findings, and treatments.
Differential Diagnosis
Polycythemia vera must be differentiated from a variety of other conditions.[1][2][3]
Disease | Mutation | Etiology | Symptoms | Signs | laboratory data | Treatment | Associated findings | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CBC | Erythropoietin level | PBS | PT/PTT | |||||||||||||||||||
JAK2 mutation | CALR mutation | Fatigue | Headache | Bleeding | Pain | Other symptoms | Appearance | Fever | Tenderness | Splenomegaly | Other signs | Hb | RBC | WBC | Plt | |||||||
Polycythemia vera (PV) | > 95% | Autonomous erythrocyte production | + | - |
|
Ruddy face | - | - | + | NA | ↑ | ↑ RBC mass | Nl to ↑ | Nl to ↑ | ||||||||
Essential thrombocythemia (ET) | 50% | +/- |
|
+ | + (paradoxical) |
|
+ | Bruises | ↑ (dysfunctional platelets) | |||||||||||||
Chronic myeloid leukemia (CML) |
|
+ | + | + | Abdominal pain | + | + | ↑ | ↑ | ↑ | ↑ | Elevated metamyelocytes and other white blood cells at various stages of maturation |
| |||||||||
Primary myelofibrosis (PMF) |
|
+ | + | Abdominal pain |
|
Pallor | + | ↓ | ↓ | ↓ | ↓ |
| ||||||||||
Secondary polycythemia | - | - |
|
+ | + | - | Depends on etiology | Cyanosis | ↑ | ↑ |
|
|
References
- ↑ Tefferi A, Barbui T (2015). "Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management". Am J Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.
- ↑ Sanchez S, Ewton A (2006). "Essential thrombocythemia: a review of diagnostic and pathologic features". Arch Pathol Lab Med. 130 (8): 1144–50. doi:10.1043/1543-2165(2006)130[1144:ET]2.0.CO;2. PMID 16879015.
- ↑ Jabbour E, Kantarjian H (2014). "Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management". Am J Hematol. 89 (5): 547–56. doi:10.1002/ajh.23691. PMID 24729196.