Elevated HgB or HCT differential Flashcards
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)
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
What if O2 saturation is above 93%?
Check for JAK V617F. If +, diagnosis is PV
What is the JAK V617F mutation is negative?
check EPO level
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
What if EPO is elevated?
Possible causes:
1) renal disease (cysts, tumors, renal artery stenosis)
2) Tumors
3) VHL mutation
4) High affinity hemoglobin
What is O2 saturation is less than 93%?
diagnosis is hypoxic erythrocytosis
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
What are some causes of secondary erythrocytosis?
- reduction of plasma volume
- appropriately increased sEPO
- inappropriately increased sEPO
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)
What things could cause appropriately increased sEPO?
- COPD
- systolic heart disease
- living at high altitudes
- sleep apnea
- obesity
- smoking
- androgens/corticosteroids
What things could cause inappropriately increased sEPO?
- renal cell carcinoma
- severe stenosis of the renal artery
- uterine fibroma
- hepatocellular carcinoma
