An Approach to the Differential Diagnosis of Pts with an Elevated Hemoglobin (Possible Polycythemia) - Flowchart
An Approach to the Differential Diagnosis of Pts with an Elevated Hemoglobin (Possible Polycythemia) - Flowchart
«Flowchart»

AN APPROACH TO DIAGNOSING PATIENTS WITH POLYCYTHEMIA

AN APPROACH TO DIAGNOSING PATIENTS WITH POLYCYTHEMIA

AN APPROACH TO DIAGNOSING PATIENTS WITH POLYCYTHEMIA

AN APPROACH TO DIAGNOSING PATIENTS WITH POLYCYTHEMIA N PPROACH TO IAGNOSING ATIENTS WITH OLYCYTHEMIA

Dx: Relative erythrocytosis

Dx: Relative erythrocytosis

Dx: Relative erythrocytosis

Increased Hct or Hb

Increased Hct or Hb

Increased Hct or Hb

Measure RBC mass

Measure RBC mass

Measure RBC mass

elevated

elevated

elevated

normal

normal

normal

End

End

End

Dx: Polycythemia vera

Dx: Polycythemia vera

Dx: Polycythemia vera

Measure serum EPO levels

Measure serum EPO levels

Measure serum EPO levels

elevated

elevated

elevated

low

low

low

Confirm JAK2 mutation

Confirm JAK2 mutation

Confirm JAK2 mutation

JAK2

Diagnostic evaluation for heart or lung disease, e.g., COPD, high altitude, AV or intracardiac shunt

Diagnostic evaluation for heart or lung disease, e.g., COPD, high altitude, AV or intracardiac shunt

Diagnostic evaluation for heart or lung disease, e.g., COPD, high altitude, AV or intracardiac shunt

Measure arterial O2 saturation

Measure arterial O2 saturation

Measure arterial O2 saturation

2

normal

normal

normal

low

low

low

Dx: Smoker’s polycythemia

Dx: Smoker’s polycythemia

Dx: Smoker’s polycythemia

Measure carboxyhemoglobin levels

Measure carboxyhemoglobin levels

Measure carboxyhemoglobin levels

elevated

elevated

elevated

normal

normal

normal

Search for tumor as source of EPO


IVP/renal ultrasound (renal Ca or cyst)
CT of head (cerebellar hemangioma)
CT of pelvis (uterine leiomyoma)
CT of abdomen (hepatoma)

Search for tumor as source of EPO


IVP/renal ultrasound (renal Ca or cyst)
CT of head (cerebellar hemangioma)
CT of pelvis (uterine leiomyoma)
CT of abdomen (hepatoma)

Search for tumor as source of EPO


IVP/renal ultrasound (renal Ca or cyst)
CT of head (cerebellar hemangioma)
CT of pelvis (uterine leiomyoma)
CT of abdomen (hepatoma)


IVP/renal ultrasound (renal Ca or cyst)
CT of head (cerebellar hemangioma)
CT of pelvis (uterine leiomyoma)
CT of abdomen (hepatoma)

Dx: !!DnArrow!! O2 affinity hemoglobinopathy

Dx: !!DnArrow!! O2 affinity hemoglobinopathy

Dx: !!DnArrow!! O2 affinity hemoglobinopathy

2

Measure hemoglobin O2 affinity

Measure hemoglobin O2 affinity

Measure hemoglobin O2 affinity

2

increased

increased

increased

normal

normal

normal

Smoker?

Smoker?

Smoker?

yes

yes

yes

no

no

no