Our expert says:
The term polycythaemia refers to an increase in red blood cells reflected as an increase in haemoglobin or packed cell volume on the full blood count. Polycythaemia may develop due to a decrease in plasma volume (relative polycythaemia) or a true increase in the total red cell mass (absolute polycythaemia).
Relative polycythaemia is found in dehydration. Absolute polycythaemia may be primary or secondary. Primary polycythaemia refers to a clonal bone marrow disease. The bone marrow produces more red cells without a cause being found. In secondary polycythaemia there is a disease causing increase of erythropoietin (hormone that stimulates red cell production) which leads to an increase in red cell production by a normal bone marrow. In some cases the erythropoietin production is appropriate - for instance if somebody lives at very high altitudes it is necessary for the body to produce more red cells to carry oxygen (less oxygen available at higher altitudes). In other cases the erythropoietin production is inappropriate and is derived from a tumor producing erythropoietin.
The work – up of a patient presenting with polycythaemia should include the following:
Exclude relative polycythaemia. This is usually obvious form the physical examination. Exclude secondary causes of polycythaemia.
If the final diagnosis is a primary polycythaemia the treatment will consist of blood letting at certain intervals depending on how active the bone marrow produces red cells. If the polycythaemia cannot be controlled with blood letting the doctor will consider a mild form of chemotherapy.
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