From the Research
For a 65-year-old male smoker with hemoglobin of 174 g/L and MCV of 99 fL, I recommend a comprehensive workup for polycythemia, prioritizing investigations that assess for polycythemia vera and secondary causes of erythrocytosis. Initial investigations should include JAK2 V617F mutation testing, serum erythropoietin level, and complete blood count with differential to evaluate for polycythemia vera 1. Additional tests should include:
- Arterial blood gas analysis to assess oxygen saturation
- Pulmonary function tests to evaluate for smoking-related lung disease
- Abdominal ultrasound to examine the spleen and liver
- Chest imaging with CT scan to rule out smoking-related lung pathology or occult malignancy. Serum ferritin, vitamin B12, and folate levels should be checked given the high-normal MCV, as suggested by the relationship between CBC components and diseases 2. The elevated hemoglobin in this patient raises concern for polycythemia vera (a myeloproliferative neoplasm) or secondary polycythemia from chronic hypoxemia due to smoking-related lung disease. The slightly elevated MCV suggests possible B12/folate issues or alcohol use which should be explored, considering the diagnosis and treatment of macrocytic anemias in adults 3. The patient should be advised to stop smoking immediately as this can worsen erythrocytosis. If polycythemia vera is confirmed, hematology consultation would be warranted for management, which might include therapeutic phlebotomy and possibly cytoreductive therapy. It is also important to consider the clinical value of routine hematological indicators in early diagnosis of ischemic stroke, as stroke patients exhibit different degrees of abnormalities in liver function test, renal function, full blood count, and lipid concentration profiles 4.