A case of Polycythemia: diagnostic dilemma
Abstract
Approach to a case of polycythemia is initially to distinguish relative from absolute polycythemia; then to distinguish Polycythemia Vera (PV) from secondary polycythemia. Finally, the etiology of secondary polycythemia has to be ascertained. A certain number of patients cannot be easily classified as having either PV or secondary polycythemia due to diagnostic difficulties. We present a case of 52-yearmale, chronic smoker, hypertensive and an asthamatic for whom a complete work up was attempted to rule out PV. There was a diagnostic difficulty as to consider this patient a case of secondary polycythemia or Gaisbock’s syndrome. We were unable to measure the red cell mass in this patient (which will be normal in Gaisbock’s syndrome and increased in secondary polycythemia). Patient underwent phlebotomy and was asymptomatic at discharge.
Downloads
References
Means TR. Erythrocytosis. In: Greer JP, Foerster J, Lukens JN, Rodgers GM, Paraskevas F, Glader B editors. Wintrobe’s Clinical Hematology Vol 1.11th edn. Lippincott: Williams & Wilkins;2004 p.1225-1237.
McMullin MF. The classification and diagnosis of erythrocytosis. Int J Lab Hematol. 2008;30(6):447-459. doi: 10.1111/j.1751-553X.2008.01102.x. Epub 2008 Sep 23.
McMullin MF, Bareford D, Campbell P, et al. Guidelines for the diagnosis, investigation and management of polycythaemia/erythrocytosis. Br J Haematol. 2005;130(2):174-195. doi:https://doi.org/10.1111/j.1365-2141.2005.05535.x.
Stefanini M, Urbas JV, Urbas JE. Gaisböck's syndrome: its hematologic, biochemical and hormonal parameters. Angiol. 1978;29(7):520-533.doi:10.1177/000331977802900703.
Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391-2405. doi: 10.1182/blood-2016-03-643544. Epub 2016 Apr 11.
Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368(1):22-33. doi: 10.1056/NEJMoa1208500. Epub 2012 Dec 8.
Berlin NI. Diagnosis and classification of the polycythemias. Semin Hematol. 1975;12(4):339-351.
Tefferi A, Rumi E, Finazzi G, et al. Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study. Leukemia. 2013;27(9):1874-1881. doi: 10.1038/leu.2013.163. Epub 2013 Jun 6.
Aitchison E, Russell N. Smoking: a major cause of polycythemia. J R Soc Med 1988;81(2): 89–91.
Dayton LM, McCullough RE, Scheinhorn DJ, Weil JV. Symptomatic and pulmonary response to acute phlebotomy in secondary polycythemia. Chest 1975;68:785-790. doi: https://doi.org/10.1378/chest.68.6.785.
Messinezy M, Pearson TC. Apparent polycythaemia: diagnosis, pathogenesis and management. Eur J Haematol. 1993;51(3):125-131. doi: https://doi.org/10.1111/j.1600-0609.1993.tb00611.x.
OAI - Open Archives Initiative
