LabMed
Elevated Hemoglobin or Hematocrit
Differential Diagnosis
Pt with true polycythemia with an increased red blood cell (RBC) mass.
Pt with a relative polycythemia and a normal RBC mass as a result of dehydration or another state producing a low plasma volume.
Dangerous Situations
Polycythemia in which the RBC mass is high enough to impair blood flow.
Commonly Encountered Situations
Polycythemia vera, also known as primary polycythemia, is not secondary to any disorder.
Polycythemia from an underlying disorder (secondary polycythemia) is much more common than primary polycythemia.
Suggested Additional Lab Testing
Serum erythropoietin level is low in primary polycythemia, unlike secondary polycythemia, so the erythropoietin (EPO) level can be useful in separating primary and secondary polycythemia.
Strict criteria are required for the diagnosis of polycythemia vera: (A1 plus A2 plus any other A) or (A1 plus A2 plus any 2B) criteria:
Increased RBC mass by hemoglobin, hematocrit, or RBC number (A1)
Erythrocytosis is not secondary to another cause (A2)
Splenomegaly (A3)
Clonal cytogenetic abnormality other than the Philadelphia chromosome (A4)
Endogenous erythroid colony formation in vitro (A5)
Platelet count greater than 400,000/µL (B1)
WBC count greater than 12,000/µL (B2)
Panmyelosis on bone marrow biopsy (B3)
Low serum EPO (B4)
Bone marrow biopsy may be useful to determine if polycythemia vera is in a hypercellular phase with greater than 60% cellularity or in a hypocellular bone marrow with markedly increased reticulin fibers.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Clinical Pain Advisor Articles
- Does Opioid Tapering in Chronic Pain Result in Controlled Pain at Taper Completion?
- MRS May Accurately Identify Painful Disks in Chronic Low Back Pain
- Patients With Chronic Pain Found to Continue Opioids Despite Little Clinical Improvement
- Slump Stretching May Be Beneficial in Low Back Pain
- Methylprednisolone May Provide Short-Term Relief From Acute Diskogenic Sciatica
- MRS May Accurately Identify Painful Disks in Chronic Low Back Pain
- Spinal Cord Stimulation Shows Long-Term Effectiveness for Refractory Neuropathic Pain
- IASP Updates Diagnosis Criteria for Chronic Primary Pain for ICD-11
- Does Opioid Tapering in Chronic Pain Result in Controlled Pain at Taper Completion?
- Color Doppler Ultrasound for the Diagnosis of Sacroiliitis in Inflammatory Back Pain
- OnabotulinumtoxinA Effective in Reducing Depression and Anxiety Symptoms in Chronic Migraines
- OnabotulinumtoxinA Improves Outcomes in Chronic Migraine With or Without Allodynia
- Multispecies Probiotics May Be Effective in Chronic, Episodic Migraine
- Mindfulness-Based Stress Reduction Also Benefits Chronic Pain
- Book a Ticket to Relaxation: Can a Vacation Stave Off Burnout?