Hematology

A myeloproliferative disorder characterized by abnormally increased number of RBCs

• Men Hct >/= 50%
• Women Hct >/= 45%

• Initial:
• - RBC mass study - elevated
• - Erythropoietin level - low/normal

• Confirm:
• - Bone marrow biopsy - hypercellular marrow

• Serial phlebotomy to Hct <45 in men; <42 women
• Daily Aspirin
• Hydroxyurea for those at high risk of thrombosis
•  - age>70, prior thrombosis, platelets>1500000, + CV risk factors
• Anagrelide - decreases platelets in refractory cases

1.5-2.0 - older pts with nonvalvular afib or recurrent systemic embolization

2.5-3.5 - pts with mechanical prosthetic valves

• Platelets - elevated
• PT - elevated
• PTT - elevated
• Fibrinogen - low
• D-dimer - elevated (d/t microvascular clotting)

• Infections
• Carcinomas
• Acute leukemia
• Trauma
• Liver disease
• Pregnancy
• Envenomations
• Transfusions

Acquired bleeding disorder characterized by low platelets, prolonged coagulation times (esp factors 5, 8, & 13), and low fibrinogen levels

The disease process causes fibrin formation and then breakdown, consuming clotting factors.  Fragmentation of RBCs can also occur as they travel through fibrin strands.