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 in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC