From the Guidelines
This patient's CBC results indicate polycythemia, with a hemoglobin level of 21.0 g/dL and hematocrit of 61%, which are above the normal ranges, and therapeutic phlebotomy should be considered if the patient is symptomatic, as per the acc/aha 2008 guidelines 1. The patient's red blood cell count is 6.82 x10^6/μL, which is significantly elevated. Key points to consider in the management of this patient include:
- The hemoglobin level is above 20 g/dL, which is a criterion for therapeutic phlebotomy in the presence of symptoms such as headache, increasing fatigue, or other symptoms of hyperviscosity, as stated in the acc/aha 2008 guidelines 1.
- The hematocrit level is 61%, which is below the threshold of 65% recommended for therapeutic phlebotomy by the acc/aha 2008 guidelines 1, but still requires careful evaluation.
- The patient should be evaluated for symptoms of hyperviscosity, such as headaches, dizziness, or visual disturbances, and referred to a hematologist for further assessment to determine the underlying cause of the polycythemia.
- Initial management may include therapeutic phlebotomy to reduce blood viscosity and prevent thrombotic complications, as well as hydration to prevent dehydration.
- Additional testing, such as JAK2 mutation analysis, erythropoietin levels, and bone marrow biopsy, may be necessary to determine whether the patient has polycythemia vera or secondary polycythemia.
From the Research
Interpretation of CBC Results
The provided CBC results show:
- RBC count: 6.82 x10E6/uL (high)
- Hemoglobin: 21.0 g/dL (high)
- Hematocrit: 61 (high)
Possible Causes
Based on the studies, the high RBC count, hemoglobin, and hematocrit levels may indicate polycythemia 2, 3. Polycythemia can be primary (polycythemia vera) or secondary, caused by hypoxic stimuli or other factors.
Characteristics of Polycythemia
- Primary polycythemia (polycythemia vera) is characterized by an increased RBC mass, often accompanied by an increased white blood cell count and platelet count 2.
- Secondary polycythemia is often caused by hypoxic stimuli, such as chronic obstructive pulmonary disease (COPD) or sleep apnea 2, 4.
- An increased hematocrit can be a risk factor for thrombosis, making it essential to diagnose and treat polycythemia promptly 3.
Evaluation and Diagnosis
- The study by 3 suggests that an hematocrit over 60% in males and over 55% in females is indicative of absolute polycythemia.
- The presence of splenomegaly, aquagenic pruritus, and erythromelalgia may indicate primary polycythemia (polycythemia vera) 3.
- Blood volume studies may be necessary to confirm the diagnosis and differentiate between primary and secondary polycythemia 3.