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Polycythemia (High Red Blood Cell Count) (cont.)

Exams and Tests

In the majority of instances, polycythemia may be detected incidentally in routine blood work ordered by a physician for an unrelated medical reason. This may then prompt further investigation to find the cause of polycythemia.

In evaluating a patient with polycythemia, a comprehensive medical history, physical examination, family history, and social and occupational history are very important. In the physical exam, special attention may be paid to the heart and lung exam. An enlarged spleen (splenomegaly) is one of the prominent features of polycythemia vera; therefore, a careful abdominal exam to evaluate for an enlarged spleen is important.

Routine blood work including a compete blood count (CBC), clotting profile, and metabolic panel are basic components of laboratory tests in assessing the cause of polycythemia. Other typical tests to determine the potential causes of polycythemia include chest X-rays, electrocardiogram (ECG), echocardiogram, hemoglobin analysis, and carbon monoxide measurement.

In polycythemia vera, usually other blood cells are also affected, represented by an abnormally high number of white blood cells (leukocytosis) and platelets (thrombocytosis). Bone marrow examinations (bone marrow aspiration or biopsy) are sometimes necessary to examine blood cell production in the bone marrow. Guidelines also recommend checking for the JAK2 gene mutation as a diagnostic criterion for polycythemia vera.

Checking Epo levels are not required, but these can sometimes provide helpful information. In primary polycythemia, the Epo level is typically low, whereas in Epo-secreting tumors, the level may be higher than normal. The results need to interpreted carefully as the Epo level may be appropriately high in response to chronic hypoxia, if that is the underlying cause of polycythemia.

Medically Reviewed by a Doctor on 5/30/2014

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