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 
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