Polycythemia resident survival guide: Difference between revisions

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Revision as of 14:06, 5 August 2020

Resident Survival Guide
Introduction
Team
Guide
Page Template
Examine the Patient Template
Navigation Bar Template
Checklist
Topics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alieh Behjat, M.D.[2]

Overview

Polycythemia is defined as increasing the hemoglobin (>16.5 g/dl in men or >16 g/dl in women) or hematocrit level (>49%in men or >48% in women).[1] This elevated level might be due to declining the plasma volume (relative or spurious polycythemia) or rising the number of red blood cells (true polycythemia). [2]

Causes

Life Threatening Causes

Common Causes

Primary polycythemia
Secondary polycythemia
  • Chronic lung disease
  • High altitude
  • EPO-producing tumors
  • High carboxyhemoglobin: mostly observed in smokers
  • Kidney diseases, such as Renal cysts and renal artery stenosis,
  • Iatrogenic reasons: steroids, erythropoietin treatment, anabolic testosterone replacement therapy. This elevated level might be due to declining the plasma volume (relative or spurious polycythemia) or rising the number of red blood cells (true polycythemia). [2]

Diagnosis

Shown below is an algorithm summarizing the diagnosis of polycythemia according to hematology guidelines. [2] [3] [4]

| | | |}} | | | |}}
 
 
 
Elevated Hgb or Hct
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess RBC mass
 
 
 
if normal
 
 
 
Relative erythrocytosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If high level
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure EPO level
 
 
 
If Low
 
 
 
Polycythemia vera
 
 
 
Check JAK2 mutation to confirm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If High level
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess arterial O2 saturation
 
 
 
If low
 
 
 
Assess cardiac or pulmunary diseases, such as right to left shunts, COPD, high altitute
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If normal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is the paitient smoker?
 
 
 
If no
 
 
 
Measure Hgb O2 affinity
 
 
 
If normal
 
 
 
Diagnostic evaluation for finding tumor producing EPO: Kidney sonography, Brain CT, Abdominopelvic Ct scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If incresed
 
 
High oxigen affinity hemoglobinopathy
 
 
 
 
 
 
 
 
 
If yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Evaluate carboxihemoglobin levels
 
 
 
 
 
 
 
If normal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
If High
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Smoker's polycythemia
 
 
 

Treatment

Shown below is an algorithm summarizing the treatment of polycythemia according to new guidelines.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

Don'ts

References

  1. Barbui T, Thiele J, Gisslinger H, Kvasnicka HM, Vannucchi AM, Guglielmelli P; et al. (2018). "The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: document summary and in-depth discussion". Blood Cancer J. 8 (2): 15. doi:10.1038/s41408-018-0054-y. PMC 5807384. PMID 29426921.
  2. 2.0 2.1 2.2 Pillai AA, Fazal S, Babiker HM. PMID 30252337. Missing or empty |title= (help)
  3. 3.0 3.1 McMullin, Mary F.; Bareford, D.; Campbell, P.; Green, A. R.; Harrison, Claire; Hunt, Beverley; Oscier, D.; Polkey, M. I.; Reilly, J. T.; Rosenthal, E.; Ryan, Kate; Pearson, T. C.; Wilkins, Bridget (2005). "Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis". British Journal of Haematology. 130 (2): 174–195. doi:10.1111/j.1365-2141.2005.05535.x. ISSN 0007-1048.
  4. Jameson, J (2018). Harrison's principles of internal medicine. New York: McGraw-Hill Education. ISBN 978-1259643996.


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