eMedicine Specialties > Hematology > Stem Cells and Disorders

Polycythemia, Secondary: Follow-up

Author: Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Coauthor(s): Ulrich Woermann, MD, Consulting Staff, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland
Contributor Information and Disclosures

Updated: Oct 4, 2009

Follow-up

Complications

  • Excessive polycythemia, usually defined as hematocrit levels higher than 65-70%, may result in increased whole blood viscosity. This, in turn, may lead to impaired blood flow locally, resulting in thrombosis. Hyperviscosity may also lead to generalized sluggish blood flow, resulting in impaired tissue oxygenation in multiple organs, which may lead to decreased mentation, fatigue, generalized weakness, and poor exercise tolerance.

Prognosis

  • The prognosis of patients with secondary polycythemia is generally related to the prognosis of the underlying disorder. However, the polycythemia itself, when physiologic and not sufficiently extreme to cause significant hyperviscosity, is generally associated with a normal life span. However, emerging evidence suggests that at a minimum, patients with congenital or familial primary polycythemia may have an increased risk of thrombosis.

Miscellaneous

Medicolegal Pitfalls

  • Distinguishing between polycythemia vera/primary polycythemia and secondary polycythemias is important, because patients with untreated polycythemia vera have a very high risk of thrombotic problems and, to a lesser degree, hemorrhagic problems, which may be fatal or severely disabling. In contrast to most patients with secondary polycythemia, patients with polycythemia vera must be phlebotomized and/or treated with myelosuppressive therapy to maintain their hematocrit values at no higher than 45-47%.
  • In patients with secondary polycythemia that is physiologic, determining the optimal hematocrit level for a given patient may be very difficult. Phlebotomies that keep very high hematocrit values (>65%) at a level low enough to prevent hyperviscosity problems may result in impaired tissue oxygenation. On the other hand, allowing the hematocrit value to remain at a higher level in order to provide better oxygen delivery capacity may result in thrombosis or general impaired tissue oxygenation due to sluggish blood flow secondary to hyperviscosity.
 


More on Polycythemia, Secondary

Overview: Polycythemia, Secondary
Differential Diagnoses & Workup: Polycythemia, Secondary
Treatment & Medication: Polycythemia, Secondary
Follow-up: Polycythemia, Secondary
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

Clinical Trials
 Clinical Guidelines

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Keywords

secondary polycythemia, polycythemia, secondary erythrocytosis, hypoxemia-induced polycythemia, myeloproliferative disorders, secondary polycythemic disorders, congenital heart disease, hypoxia, tissue hypoxia, blood disorder, hematologic disorder, secondary blood disorder, erythrocythemia, Chuvash polycythemia

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Contributor Information and Disclosures

Author

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Coauthor(s)

Ulrich Woermann, MD, Consulting Staff, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland
Disclosure: Nothing to disclose.

Medical Editor

Karen Seiter, MD, Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, and American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching; Schering Honoraria Speaking and teaching; Cephalon Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Koyamangalath Krishnan, MD, FRCP, FACP, Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians
Disclosure: Nothing to disclose.

 
 
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