Polycythemia

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?