Teaching Cases - American Society of Hematology


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Teaching Cases

Polycythemia — Virginia C. Broudy, MD
University of Washington School of Medicine, Seattle, WA

I. History	II. Physical Exam	III. Laboratory Data	IV. Differential Diagnosis
V. Pathophysiology	VI. Prognosis/Clinical Course	VII. Teaching Points	VIII. Bibliography

VII. TEACHING POINTS

The three pathophysiologic categories of polycythemia are:

Comparison of Polycythemia Vera and Secondary Polycythemia
	Polycythemia Vera	Secondary Polycythemia
Pathophysiology	Neoplastic hematopoietic stem cell disorder	Due to tissue hypoxia causing an appropriate increase in Epo production, or to renal or hepatic disease causing an inappropriate increase in Epo production
CBC	Hct and often WBC and platelets are increased	Only Hct is increased
Epo level	Decreased or low normal	Normal or increased
Treatment	Phlebotomy and/or hydroxyurea to keep Hct below 46% (men) or below 43% (women); most patients should also take aspirin 81 mg daily to decrease the risk of thrombosis.	Treatment is usually not required

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