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Further investigations of erythrocytosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Useful investigations for distinguishing primary and secondary erythrocytosis include:

  • FBC:
    • the following are present only in primary erythrocytosis:
      • white cell count shifted to left (neutrophils)
      • platelets and nucleated red blood cells increased

  • ESR is usually low (less than 5mm/h) in both primary and secondary disease

  • leukocyte alkaline phosphatase:
    • raised in primary disease but may also be raised in infection or thrombosis

  • vitamin B12 levels are increased in primary disease, predominantly due to increased transcobalamin III levels

  • chest X-ray

  • abdominal ultrasound or CT:
    • to detect renal, hepatic or uterine pathology, and/or hepatosplenomegaly may be positive in secondary disease

  • arterial oxygen tension (PaO2) and O2 saturation measurement - decreased in secondary disease

  • haemoglobin O2 affinity (P50) - may be raised in secondary disease if high affinity abnormal haemoglobins

  • radioimmunoassays, ELISA - to measure serum levels of erythropoietin; raised in secondary erythrocytosis

  • in vitro culture of erythroid progenitors - occurs without addition of erythropoietin in primary disease; only available in specialist labs

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