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 PTS WITH POLYCYTHEMIA

Increased Hct or hgb

AN APPROACH TO DIAGNOSING PTS WITH POLYCYTHEMIA

Increased Hct or hgb

AN APPROACH TO DIAGNOSING PTS WITH POLYCYTHEMIA

AN APPROACH TO DIAGNOSING PTS WITH POLYCYTHEMIA

Increased Hct or hgb

Measure RBC mass

Measure RBC mass

Measure RBC mass

Measure serum EPO levels

Measure serum EPO levels

Measure serum EPO levels

Dx: Relative erythrocytosis

Dx: Relative erythrocytosis

Dx: Relative erythrocytosis

Dx: Polycythemia vera

Dx: Polycythemia vera

Dx: Polycythemia vera

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

Dx: Smoker's polycythemia

Dx: Smoker's polycythemia

Dx: Smoker's polycythemia

Dx: O2affinity hemoglobinopathy

Dx: O2affinity hemoglobinopathy

Dx: O2affinity hemoglobinopathy

2

Search for tumor as source of EPO


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


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


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


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

End

End

End

Measure arterial O2 saturation

Measure arterial O2 saturation

Measure arterial O2 saturation

2

normal

normal

normal

low

low

low

Smoker?

Smoker?

Smoker?

yes

yes

yes

no

no

no

Measure hemoglobin O2 affinity

Measure hemoglobin O2 affinity

Measure hemoglobin O2 affinity

2

increased

increased

increased

normal

normal

normal

Measure carboxyhemoglobin levels

Measure carboxyhemoglobin levels

Measure carboxyhemoglobin levels

elevated

elevated

elevated

normal

normal

normal

Confirm JAK2 mutation

Confirm JAK2 mutation

Confirm JAK2 mutation

JAK2

AV, atrioventricular; COPD, chronic obstructive pulmonary disease; CT, computed tomography; EPO, erythropoietin; Hct, hematocrit; hgb, hemoglobin; IVP, intravenous pyelogram; RBC, red blood cell.

AV, atrioventricular; COPD, chronic obstructive pulmonary disease; CT, computed tomography; EPO, erythropoietin; Hct, hematocrit; hgb, hemoglobin; IVP, intravenous pyelogram; RBC, red blood cell.

AV, atrioventricular; COPD, chronic obstructive pulmonary disease; CT, computed tomography; EPO, erythropoietin; Hct, hematocrit; hgb, hemoglobin; IVP, intravenous pyelogram; RBC, red blood cell.

elevated

elevated

elevated

low

low

low

Measure serum EPO levels

Measure serum EPO levels

Measure serum EPO levels

elevated

elevated

elevated

normal

normal

normal