Case

57 yo M with hypertension, otherwise well, is referred to you with the following CBC:

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See Polycythemia/Erythrocytosis – Definitions and Classification

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See Polycythemia/Erythrocytosis – Definitions and Classification

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See Polycythemia/Erythrocytosis – Definitions and Classification

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See Polycythemia/Erythrocytosis – Definitions and Classification

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Note: There are rare causes of secondary polycythemia that are not mediated b y elevated levels of EPO – for example, testosterone and Cushing syndrome.

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You take a history and find the patient is asymptomatic, otherwise well, but smokes > 5 cigars/day (a clue is the leukocytosis). Which of the following tests would you order:

a
Creatinine
Many types of renal disorders can increase erythropoietin production from peritubular cells.
b
MPL and CALR mutations
These are often checked in patients with suspected essential thrombocythemia.
c
CarboxyHb
d
SaO2
e
TSH

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The carboxyHb level returns at 18%. Note that the finger oximeter reported an SaO2 of 96%. However, this device cannot distinguish between oxyHb and carboxyHb, so the 96% reflects combination of oxyHb + carboxyHb.

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