Difference between revisions of "Polycythemia"
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==Initial evaluation== | ==Initial evaluation== | ||
Latest revision as of 18:50, 15 March 2018
Initial evaluation
May consist of:
- CBC with differential
- Pulse oximetry
- Serum erythropoetin
- JAK2 (V617F, exon 12 mutation)
- Comprehensive metabolic panel (CMP)
- Reticulocyte count
- Iron, total iron binding capacity (TIBC), ferritin
- Clinical history of arterial or venous thromboembolism (VTE), stroke, post-bathing pruritis, facial plethora, headache, fatigue, visual changes
Secondary polycythemia?
- Smoking
- Chronic lung disease
- Obstructive sleep apnea (OSA)
- Carbon monoxide (CO) exposure
- Home heating: natural gas or oil?
- Carbon monoxide detectors?
- Carboxyhemoglobin
- High altitude environments
- Testosterone use
- Erythropoetin use
- Athletic blood doping/transfusions
- Right to left cardiac shunt
- Dehydration/diuretic use
Additional considerations
- Renal ultrasound or other imaging to evaluate for erythropoetin-secreting renal tumor, pheochromocytoma
- Chest x-ray
- Urinalysis
- Family history of high oxygen affinity hemoglobinopathies?
- Cushing's syndrome?
- Congenital polycythemia?