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What is EPO level in primary polycythemia?
low
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What is EPO level in secondary polycythemia?
Elevated
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Primary polycythemia is :
Polycythemia rubra vera
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Secondary polycythemia has these branch points:
- Appropriate EPO elevation
- Inappropriate EPO elevation
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Causes of appropriate EPO elevation in secondary polycythemia:
- Pulmonary
- Cardiac
- Hemoglobin abnormalities
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Causes of inappropriate EPO elevation in secondary polycythemia:
- Renal
- Pharmacologic
- EPO production from tumors
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Polycythemia is _____ plasma volume, ______ RBC mass, and _____ blood volume
- Decreased
- Increased
- Normal
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T/F: polycythemia is typically of normal physiology
True. Except for some uncommon exceptions: carbon monoxide exposure, congenital hemoglobinopathies, polycythemia rubra vera
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T/F: polycythemia usually results in hemolytic anemia
False; RBC survival is usually normal in polycythemia
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What happens to viscosity with increased red cell mass and decreasing plasma volume
Viscosity rises
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When hematocrit is above ____, think polycythemia
Above 55%
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What is artifactual polycythemia?
Manifests as increases in hemoglobin or hematocrit measured on a CBC when plasma cell volume is decreased rather than the RBC mass increased
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Is serum EPO normal in artifactual polycythemia?
Yes, it is
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Reduced plasma volume and reduced whole blood volume while maintaining same number of RBCs is_____ polycythemia
Spurious
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What could be some causes that leads to decreased plasma volume causing spurious polycythemia?
- Caffeine excess
- Gaisboch’s syndrome – chronic plasma volume reduction seen in type A middle aged executives using caffeine and tobacco.
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Gisboch’s syndrome can cause ____
Decreased plasma volume and spurious polycythemia
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Polycythemia rubra vera indicates that the bone marrow is making cell _____ (with/ without) EPO stimulation
Without, that’s why there is increased red cell mass with low EPO
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Serum erythropoietin genetic site and which receptor they bind to?
- Chromosome 7
- Target site is JAK-2 reeptor in the blast
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T/F: polycythemia rubra vera is a low grade malignancy
True
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This polycythemia is a primary disease of the bone marrow itself:
Polycythemia rubra vera (primary) – could led to increased white blood cell and platelets
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Low serum EPO, splenomegaly and presence of JAK-2 mutation is this polycythemia:
Polycythemia rubra vera (primary)
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T/F: you almost want to get iron deficiency in patient with polycythemia rubra vera (primary)
True
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What is the cardiac causes of secondary polycythemia:
- Right to Left shunt (congenital)
- Cyanosis
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