Elevated HgB or HCT differential Flashcards Preview

Heme Week 2 > Elevated HgB or HCT differential > Flashcards

Flashcards in Elevated HgB or HCT differential Deck (12):
1

After seeing the HgB/HCT is elevated what should you do next?

check red cell mass and plasma volume (today HgB above 18.5 in men and above 16.5 in women is considered the same as an elevated RCM)

2

What if red cell mass is elevated (i.e. if hemoglobin is above 18.5 in men and 16.5 in women)?

check O2 saturation

3

What if O2 saturation is above 93%?

Check for JAK V617F. If +, diagnosis is PV

4

What is the JAK V617F mutation is negative?

check EPO level

5

What is EPO is normal or low?

Possible causes:
1) PV (JAK2 exon 12 mutation)
2) Sleep apnea
3) EPO-receptor mutation
4) renal disease (cysts, tumors, renal artery stenosis)
5) Tumors
6) High affinity hemoglobin

6

What if EPO is elevated?

Possible causes:
1) renal disease (cysts, tumors, renal artery stenosis)
2) Tumors
3) VHL mutation
4) High affinity hemoglobin

7

What is O2 saturation is less than 93%?

diagnosis is hypoxic erythrocytosis

8

What are the possible causes if RCM is normal and plasma volume is decreased?

Possible causes:
1) tobacco use
2) androgens
3) diuretics
4) Hypertension
5) Pheochromocytoma

9

What are some causes of secondary erythrocytosis?

-reduction of plasma volume
-appropriately increased sEPO
-inappropriately increased sEPO

10

What things could cause reduction of plasma volume?

-acute vomiting or diarrhea
-severe burns
-diabetic ketoacidosis
-chronic use of diuretics
-Giasbock syndrome (seen hypetensive, middle aged male smokers)

11

What things could cause appropriately increased sEPO?

-COPD
-systolic heart disease
-living at high altitudes
-sleep apnea
-obesity
-smoking
-androgens/corticosteroids

12

What things could cause inappropriately increased sEPO?

-renal cell carcinoma
-severe stenosis of the renal artery
-uterine fibroma
-hepatocellular carcinoma