From the Guidelines
For a 44-year-old female with elevated hemoglobin/hematocrit (h/H), the initial workup should include a comprehensive diagnostic evaluation as outlined in the American Society of Clinical Oncology clinical practice guideline, including history and physical examination, blood chemistry, CBC, LDH, haptoglobin, bilirubin, reticulocyte count, and free hemoglobin, among other tests 1. The workup should prioritize identifying potential causes of hemolysis, autoimmune disorders, and other underlying conditions that may be contributing to the elevated h/H.
- Key components of the workup include:
- History and physical examination to identify potential triggers or underlying conditions
- Blood chemistry and CBC to assess for evidence of anemia, macrocytosis, and hemolysis
- LDH, haptoglobin, bilirubin, reticulocyte count, and free hemoglobin to evaluate for hemolysis and liver function
- Disseminated intravascular coagulation panel and autoimmune serology to rule out coagulopathy and autoimmune disorders
- Paroxysmal nocturnal hemoglobinuria screening and direct and indirect bilirubin testing to evaluate for hemolytic anemia
- Evaluation for viral/bacterial causes of hemolysis and common drug causes of hemolysis
- Assessment of methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency The goal of the workup is to identify the underlying cause of the elevated h/H and develop an appropriate treatment plan to reduce the risk of morbidity and mortality, while also improving quality of life.
- It is essential to consider the potential risks and benefits of each diagnostic test and to prioritize those that are most likely to yield useful information.
- The workup should be individualized based on the patient's specific presentation and medical history, and may involve consultation with a hematologist or other specialist if necessary.
- In contrast to other conditions, such as polycythemia vera, where JAK2 V617F mutation testing and erythropoietin level may be relevant, the initial workup for elevated h/H in this patient should focus on the comprehensive diagnostic evaluation outlined in the American Society of Clinical Oncology clinical practice guideline 1.