Hematology Issues & Polycythemia

Question 1

Anemia of Chronic Disease

Answer 1

May be microcytic or normocytic
Common causes are inflammation, infection &/or underlying malignancy
If pt has chronic renal failure, mechanism is a production of erythropoiten and is usually more severe
If the inflammation is in the GI tract it may lead to occult and progressive blood loss
In labs the Hmct rarely falls below 60%, MCV & retic count are normal, RBC morphology is normal
Usually does not require treatment

Question 2

Polycythemia Vera

Answer 2

Is an increase in blood viscosity,
Typed as “relative” or “absolute”
HMCT> 51% in women & >54% in men is characteristic
Is prevalent in older men (2:1 ratio males:females of the same age)

Question 3

Relative Polycythemia

Answer 3

Is r/t dehydration- acute or chronic
Acute dehydration occurs with burns, fevers, vomiting
Chronic dehydration occurs with long term diuretic use, decreased oral fluid intake
Cigarette smoking decreases plasma volume and is a contributing factor

Question 4

Absolute Polycythemia

Answer 4

Actual numbers of erythrocytes are increased
Primary polycythemia is familial & congenital
Secondary polycythemia is caused by factors such chronic hypoxia cardiopulmonary disease
Can also be acquired by prolonged high-altitude living, cigarette smoking (carboxyhemoglobinuria),
Cushing’s syndrome, chronic steroid use & blood doping

Question 5

Polycythemia Vera Symptoms

Answer 5

Symptoms do not occur usually until Hgb>60%
Common complaints are headache, blurred vision, weakness, fatigue, irritability, dizziness, GI symptoms and epistaxis
An unusual common finding is itching after a warm shower- due to the histamine release from the basophils in the dilated vessels
Also a work & smoking history because of carbon monoxide exposure (garage attendants, cab drivers, bus drivers) & methomeglobin

Question 6

Polycythemia Vera Objective Findings

Answer 6

Assess for venous or arterial thrombosis
Changes in the eye grounds
Splenomegaly
Pulse Ox
Skin is dark
Cushingoid appearance
CBC
? Bone marrow biopsy
Referral

Question 7

Polycythemia Vera Tx

Answer 7

Rehydration
Frequent phlebotomies
ASA therapy, Hydrea
Usually this is beyond primary care and is specialist care