Symptoms and lab results of Relative polycythemia

* Signs and Symptoms

nOften individual has no complaints or vague complaints (e.g., headache, fatigue) with ruddy complexion and slight hypertension .

· Laboratory Diagnosis

nNormal RBC mass .

nElevated hematocrit .

n No leukocytosis .

nNormal bone marrow studies .

* Treatment

nReplacing fluids and removing causative disorders .

*Complications

Hypercholesterolemia, hyperlipidemia , and hyperuricemia may complicate relative polycythemia.

what is Relative polycythemia

Relative polycythemia

n Also known as (stress polycythemia) or (pseudopolycythemia) .

n Results from reduction of plasma volume which is caused by loss of body fluids , such as through burns, dehydration and stress .

n The total number of RBCs is normal .

n affects middle-aged men and is associated with smoking , increased alcohol  intake .

n May be caused be cardiovascular problems (e.g. hypertension ) .

Lab results for Secondary polycythaemia

Laboratory Diagnosis

n Elevated erythrocytes (6 - 8 and occasionally 9 millions per mm3)

n Elevated PCV , Hb, and “mean corpuscular volume” MCV .

n No leukocytosis or thrombocytosis .

n Selective erythroid hyperplasia of bone marrow .

n Increased circulating reticulocytes .

Symptoms of Seconday Polycythaemia

Signs and Symptoms

n Similar to primary polycythemia plus hypoxemia (low arterial blood O2) in the absence of hepatosplenomegaly and hypertension .

n  Clinical features also differ according to the causative disorders .

What is Seconday Polycythaemia

Secondary polycythemia

n Also called (physiologic polycythemia) .

n caused by either natural or artificial increases in the production of erythropoietin , leading to increased production of erythrocytes .

n  Erythropoietin production is stimulated by (tissue hypoxia) or (certain diseases).

n The incidence is about 2 in 100,000 people in the United States .

* Tissue hypoxia occurs due to :

n chronic obstructive pulmonary disease .

n hemoglobin abnormalities such as carboxyhemoglobinemia (in smokers) .

n congenital heart disease .

n Altitude stress - This physiologic polycythemia is a normal adaptation to living at high altitudes (over 10,000 feet) .

* overproduction of Erythropoietin

n polycystic kidney disease .

n hydronephrosis .

n renal neoplasms .

Tumers of kidney , liver , or adrenal glands

primary Polycythaemia Complications

Complications

n Thrombosis, cerebrovascular insult, peptic ulcers, myeloid metaplasia, leukemia, and hemorrhage are common complications that result in the death of about 50% of untreated individuals within 18 months of the appearance of symptoms.

n  The median survival rate in treated individuals is 7 to 15 years.

primary Polycythaemia Laboratory Diagnosis

Laboratory Diagnosis

n Hb    , PCV (60 - 70) % .

n RBC Count increases (8 - 9 up to 11 millions per mm3) .

n Leukocytes & platelets increase .

n Erythropoietin level is low .

n Elevated serum vitamin B12 .

n decreased serum iron concentration .

n increased blood histamine .

what is Primary Polycythaemia

)  Primary polycythemia

n Also called : Polycythemia vera or Erythremia .

n occurs when excess red blood cells are produced as a result of an abnormality of the bone marrow (hyperplasia) . 

n The cause of hyperplasia is unknown .

* Description

n It is a rare disease that occurs more often in men than women, and is rare in patients under age 40 .

n It may be chronic and fatal .

n It occurs in 1 in 200,000 people in the United States .

n It is more common in whites, particularly Jews of European ancestry.

n It also increases leukocytes (leukocytosis) and platelets (thrombocytosis) .

n The danger from erythrocytosis is that it causes blood volume and blood viscosity to increase, along with the erythrocyte count. The liver and spleen become increasingly congested with erythrocytes as viscosity causes blood flow to slow.

n  Eventually, the thick, sticky, slow-flowing blood becomes an ideal environment for clotting and acidosis. If thrombi obstruct vessels, the result is blood deprivation of tissues and organs.

Primary Polycythaemia Treatment

Treatment

n Treatment focuses on treating symptoms and reducing thrombotic complications by reducing the erythrocyte levels .

n A method called phlebotomy is used to decrease blood thickness. One pint of blood is removed weekly until the hematocrit level is less than 45, then therapy is continued as needed.

n Phlebotomy is a procedure in which a vein is opened and blood is removed .

n Myelosuppressive drugs (marrow suppressants) are also used, but their effects can be more unpleasant than the disease.

n Low dose aspirin (75–81 mg daily) is often prescribed to reduces the risk for various thrombotic complications (effect epigastric)

n Interferon may also be given in an attempt to lower blood counts .

n Splenectomy to treat resistant splenomegaly .

n Antihistamines relief pruritus (itching) .

symptomps of polycythaemia

SYMPTOMS
• Breathing difficult when lying
• Red colouration, especially on face
• Dizziness
• Headache
• Itchiness
• Red skin spots
• Vision problem
• vertigo

EFFECTS OF POLYCYTHEMIA ON BODY
REFERENCES.
• Increases blood viscocity.
• Slows the rate of blood flow.
• Increases blood pressure.
• Increased platelets leads to intravascular thrombi.
• Increased risk of Ischaemia andInfarction

Primary Polycythaemia Treatment

Treatment

n Treatment focuses on treating symptoms and reducing thrombotic complications by reducing the erythrocyte levels .

n A method called phlebotomy is used to decrease blood thickness. One pint of blood is removed weekly until the hematocrit level is less than 45, then therapy is continued as needed.

n Phlebotomy is a procedure in which a vein is opened and blood is removed .

n Myelosuppressive drugs (marrow suppressants) are also used, but their effects can be more unpleasant than the disease.

n Low dose aspirin (75–81 mg daily) is often prescribed to reduces the risk for various thrombotic complications (effect epigastric)

n Interferon may also be given in an attempt to lower blood counts .

n Splenectomy to treat resistant splenomegaly .

n Antihistamines relief pruritus (itching) .

symptomps of polycythaemia

SYMPTOMS
• Breathing difficult when lying
• Red colouration, especially on face
• Dizziness
• Headache
• Itchiness
• Red skin spots
• Vision problem
• vertigo

EFFECTS OF POLYCYTHEMIA ON BODY
REFERENCES.
• Increases blood viscocity.
• Slows the rate of blood flow.
• Increases blood pressure.
• Increased platelets leads to intravascular thrombi.
• Increased risk of Ischaemia andInfarction

Polycythaemia overview

POLYCYTHEMIA
LEARNING OBJECTIVE

At the end of lecture student should be able to know,
• Polycythemia,
• Types of polycythemia,
• Symptoms of polycythemia.
• Effects of polycythemia.



DEFINATION
• A condition in which there is an increase in the red blood cells count in circulation.

Polycythemia
• It is measured as hematocrit level.
• It occur in both physiological and pathological
conditions.

TYPES OF POLYCYTHEMIA
1. Relative polycythemia

1. Absolute Polycythemia
a. Physiological
b. Pathological (Primary and secondary)




1. RELATIVE POLYCYTHEMIA
• This occur when RBCs count is normal but blood volume is reduced by fluid loss.

• Eg excessive serum oxudate from extensive superficial burn, dehydration etc


2. ABSOLUTE POLYCYTHEMIA
It is occur when RBCs count truly increased.

It may be Physiological or Pathological

PHYSIOLOGICAL POLYCYTHEMIA
• When number of RBCs increases in physiological conditions is called physiological polycythemia.
• Increase in number is marginal and temporary

CAUSES OF PHYSIOLOGICAL POLYCYTHEMIA
1. AGE
At birth 8-10 million/cu mm of blood
In children RBCs count is more than adult.

2. SEX
Before puberty and after menopause RBCs count similar to male
1. High altitude
10,000ft above sea level, RBCs count of more than 7million/cu mm of blood due to hypoxia

4. Muscular exercise
Temporary increase in RBC count

PATHOLOGICAL POLYCYTHEMIA
The abnormal increase in RBC count is called pathological polycythemia.

1. PRIMARY PLYCYTHEMIA
( Polycythemia vera )

2. SECONDARY POLYCYTHEMIA


WHAT IT IS ?
• It is primary polycythemia

• RBC count increases 14 million/cu mm

• Associated with increased WBCs count above 24000/cu mm of blood

CAUSES
Polycythemia vera occur in:

• Myeloproliferative disorders.

• Malignancy of red bone marrow.

• Some times mutation of body’s gene JAK which

make protein that helps RBCs production , even it is not genetic disorder

SECONDARY POLYCYTHEMIA
Increased level of erythropoietin due to :
• Disorder that decreases O2 carrying capacity of Hb.
High altitude
Pulmonary diseases
Congestive heart failure

• Tumors of liver, brain, Pituitary, Kidney

What is Polycythaemia or polycythemia

Polycythemia (also known as polycythaemia or erythrocytosis) is a disease state in which the proportion of blood volume that is occupied by red blood cells increases. Blood volume proportions can be measured as hematocrit level.