Polycythaemia

Background

  • Men: Hb > 185, Hct > 0.52
  • Women: Hb > 160, Hct > 0.48
  • Causes of polycythaemia
    • Apparent
      • Reduced playsma volume
      • Obesity, smoking, alcohol, hypertension, stress, dehydration diuretics
    • Absolute
      • Polycythaemia Rubra Vera – 90% are JAK2 positive
      • Secondary polycythaemia – hypoxia (COPD, heart disease, smoking) / abnormal EPO production (renal/ liver tumours, fibroids)

 

Assess

  • Assess WCC and platelets
    • WCC and platelets normal
      • Probable secondary polycythaemia
    • WCC, platelets and basophils raised, ferritin low
      • Probable primary polycythaemia

 

Management

  • History: Neurological symptoms, visual loss, bleeding, thrombosis
  • Investigate: Monitor FBC, modify lifestyle factors, check
  • Refer if
    • Hct > 0.52 males + previous thrombosis, splenomegaly, pruritus, elevated WCC/platelets
    • Hct > 0.48 females + previous thrombosis, splenomegaly, pruritus, elevated WCC/platelets
    • Persistent, unexplained raised Hct over 4 weeks apart
  • 2 week referral
    • Hb  >200 g/l
    • Hct > 0.60 (in absence of chronic hypoxia)
    • Raised Hb associated with thrombosis, neurological symptoms, visual loss, bleeding