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

When Should I Call the Doctor About Polycythemia?

People with primary polycythemia need to be aware of some of the potentially serious complications that may occur. The formation of blood clots (heart attacks, strokes, blood clots in the lungs [pulmonary embolism] or legs [deep vein thrombosis]) and uncontrolled hemorrhaging (nosebleeds, gastrointestinal bleeding) typically require prompt medical attention by the treating physician or emergency department.

Patients with primary polycythemia are usually cared for by their primary care physicians, internists, family physicians, and hematologists (doctors who specialize in blood disorders).

Conditions leading to secondary polycythemia can be managed by primary care physicians and internists in addition to specialists. For example, people with long- standing lung disease may routinely see their lung doctor (pulmonologist) and those with chronic heart disease may see their heart doctor (cardiologist).

What Are the Exams and Tests Used to Diagnose Polycythemia?

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 11/21/2017

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