Polycythaemia
OVERVIEW
Polycythaemia = elevated Hb concentration from either increased RBC mass or decreased plasma volume
TYPES
Primary
- polycythaemia rubra vera
Secondary
- chronic hypoxaemia (cyanotic congenital heart disease, chronic pulmonary hypertension…)
- renal lesions (RCC, renal artery stenosis)
- hepatic lesions (hepatocellular carcinoma, cirrhosis)
- endocrine tumours (EPO secreting)
- other tumours (bronchial tumours)
- androgens
Relative (decreased plasma volume)
- dehydration (diuretics and alcohol), stress polycythaemia
CLINICAL FEATURES
- plethora
- fundal hyperviscosity
- hypertension
- splenomegaly
- generalised pruritis
- bleeding tendency (platelet dysfunction)
- PVD
- IHD (thrombosis and slow circulation)
- gout
INVESTIGATIONS
- FBC: elevated Hb, elevated HCT
- polycythaemia rubra vera: increased WCC and platelets, microcytosis and slight anisocytosis
- 51Cr- labelled red cell mass distinguishes between increased red cell mass and decrease plasma volume.
MANAGEMENT
- treat cause!
- polycythaemia rubra vera:
-> venesection
-> consider myelosuppression if has developed a thrombotic complication (hydroxyurea, radiophosphorus, interferon alpha, anagrelide) + aspirin
COMPLICATIONS
- PVD
- IHD
- APO
- thrombosis
- CVA
- gout
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC