Hemeonc 8

Question 1

What is the diagnosis if you see an increase in RBC mass with a Hct >55%?

Answer 1

Erythrocytosis

Question 2

What are causes of primary, secondary, and relative erythrocytosis?

Answer 2

Primary–causes itself (Polycythemia Vera)
Secondary–increased erythropoietin (altitude, tumor)
Relative–decreased plasma volume (dehydration)

Question 3

What is the diagnosis if you see an increase in RBC mass with a Hct >55%, a mutation of JAK2, normal or low erythropoietin levels, and a BMbx showing hypercellularity in relation to the patient’s age?

Answer 3

Polycythemia Vera

Question 4

What is happening to the blood in polycythemia vera?

Answer 4

Hyperviscosity, hypervolemia, inappropriate bleeding

Question 5

What clinical symptoms are common in polycythemia vera?

Answer 5

Pruritus especially after showering
Headache
Weakness
vertigo
Excessive sweating
Tinnitus 
Visual disturbances
VTE
Erythromelalgia (burning of hands and feet)
Early satiety (enlarged spleen)
Peptic ulcer

Question 6

What is the tx of polycythemia vera?

Answer 6

phlebotomy (“bleeding them”)
ASA
hydroxyurea (decreases RBC/PLT production)
IFA (interferon alpha)

Question 7

Tumors in what 2 areas are likely to increase secretion of erythropoietin, leading to a secondary erythrocytosis?

Answer 7

Renal carcinomas and Liver tumors

Question 8

Would hypoxia increase the production of erythropoietin? Why?

Answer 8

Yes. If tissues need more oxygen, the kidneys release the hormone erythropoietin to increase volume of RBC’s

Question 9

So if you test the erythropoietin (epo) level in a patient and find that it is high, would you consider a primary or secondary erythrocytosis?

Answer 9

Secondary

Question 10

What are two factors that could contribute to relative erythrocytosis?

Answer 10

Dehydration, diuretics

Question 11

How would you treat secondary and relative erythrocytosis?

Answer 11

Treat underlying condition