High Hb It is important first to ascertain the validity of this result if it does not tie in with known clinical findings. At this point, exclude dehydration and diuretic therapy which may both increase the haematocrit (Hct). Anoxia is the major stimulus to red blood cell production and therefore an elevated Hb may be found: Where there has been recent travel to high altitude (>3,000 m). In hypoxic respiratory conditions - eg, chronic obstructive pulmonary disease (COPD). Heavy cigarette smoking (as a result of increased carboxyHb levels). Ventilatory impairment secondary to gross obesity and alveolar hypotension. Secondary causes such as: Spurious polycythaemia (pseudopolycythaemia or Gaisbocks syndrome) - hypertensive, obese, cigarette smokers who drink to excess. Primary proliferative polycythaemia (polycythaemia rubra vera) - plethoric facies with a history of pruritus after change of environmental temperature/bathing, and splenomegaly. Inappropriate erythropoietin excess - this occurs in a variety of benign and malignant renal disorders. May also be a rare complication of some tumours - eg, hepatoma, uterine fibroids and cerebellar haemangioblastoma. In these patients, there must be an additional evaluation of the risk of thrombosis.
Posted on: Tue, 03 Dec 2013 22:08:57 +0000
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