1/38. Giant myoma and erythrocytosis syndrome.The objective of this study is to discuss the myomatous erythrocytosis syndrome in a patient with a giant subserous uterine myoma. She presented with plethora and an abdominal mass. After venesection of 4 units of blood, the preoperative haematocrit value of 53.3% and haemoglobin value of 17.5 g/dL had decreased to 48.6% and 16.8 g/dL levels, respectively. After the operative extraction of the giant subserous myoma with attached uterus weighing 14.2 kg, the haematocrit and the haemoglobin values had regressed to 40.3% and 14.3 g/dL levels, respectively. The findings indicated that the giant subserous myoma was the cause of the myomatous erythrocytosis syndrome in this patient.- - - - - - - - - - ranking = 1keywords = venesection (Clic here for more details about this article) |
2/38. Simultaneous occurrence of multiple aetiologies of polycythaemia: renal cell carcinoma, sleep apnoea syndrome, and relative polycythaemia in a smoker with masked polycythaemia rubra vera.A 58 year old male heavy smoker presented with intracranial haemorrhage and erythrocytosis. Four aetiologies of polycythaemia--polycythaemia rubra vera (PRV), renal cell carcinoma, sleep apnoea syndrome, and relative polycythaemia--were found to be associated with the underlying causes of erythrocytosis. He did not fulfill the diagnostic criteria for PRV at initial presentation, but an erythropoietin independent erythroid progenitor assay identified the masked PRV, and the low post-phlebotomy erythropoietin concentration also suggested the likelihood of PRV evolution. This case demonstrates that a search for all the possible causes of erythrocytosis is warranted in patients who already have one aetiology of polycythaemia.- - - - - - - - - - ranking = 0.55145116011259keywords = phlebotomy (Clic here for more details about this article) |
3/38. A rare case of renal hemangioma presenting as polycythemia.Instances of renal cell carcinoma and erythropoietin-producing renal cysts presenting as polycythemia are well documented. To our knowledge, no case of hemangioma presenting as polycythemia has been reported. We present a case of a 39-year-old man with a 5-year history of polycythemia requiring phlebotomy every 3 months. Computed tomography revealed a 6 to 7-cm right upper pole renal mass. The patient underwent right radical nephrectomy, and pathologic examination revealed the mass to be a capillary hemangioma. The patient has not required phlebotomy for 1 year since the removal of the hemangioma.- - - - - - - - - - ranking = 1.1029023202252keywords = phlebotomy (Clic here for more details about this article) |
4/38. Primary pulmonary hypertension with severe systemic hypertension, Raynaud's phenomenon and relative polycythemia.A 32-year-old Japanese man was hospitalized for evaluation of unconsciousness. He was diagnosed as having primary pulmonary hypertension (PPH) with severe systemic hypertension, Raynaud's phenomenon and relative polycythemia. Hemostatic studies revealed increased coagulation and decreased fibrinolysis, similar to findings of chronic disseminated intravascular coagulation (DIC). Although activation of coagulation and systemic hypertension were improved after treatment with phlebotomy and administration of nifedipine, enerapril and warfarin, pulmonary hypertension was unchanged, suggesting that irreversible change had already occurred in the pulmonary arteries. Those complications could modify the process of pulmonary hypertension by inducing a hyperviscosity state.- - - - - - - - - - ranking = 0.55145116011259keywords = phlebotomy (Clic here for more details about this article) |
5/38. Spurious polycythemia.Spurious polycythemia is not a primary disease process. It sometimes may be nothing more than an unusual, but normal, physiologic state. In other instances, however, it is associated with a true abnormality of plasma volume. Although there is probably overlap between these extremes, differentiation of these subclasses may be of prognostic significance. The elevation in hematocrit bears no relation to morbidity, and, because there is no evidence of abnormal erythroid proliferation, reduction of red cell volume via phlebotomy or myelosuppression is inappropriate. Nonhematologic parameters, particularly hypertension, are the major factors of significance in the substantial cardiovascular morbidity in spurious polycythemia, and they demand attentive and aggressive management.- - - - - - - - - - ranking = 0.55145116011259keywords = phlebotomy (Clic here for more details about this article) |
6/38. A case of sickle-cell erythrocytosis occurring following renal transplantation.We present an unusual case of post-renal transplant 'erythrocytosis' in a patient with sickle-cell anaemia, who had developed renal failure following the effects of a phaeochromocytoma. Prior to transplantation, the patient had experienced only occasional crises. However, post-transplant, he experienced multiple and varied crises, associated with a significant increase in haemoglobin concentration. These symptoms were partially alleviated by regular venesection.- - - - - - - - - - ranking = 1keywords = venesection (Clic here for more details about this article) |
7/38. life-threatening thrombotic complications of relative polycythaemia.Relative polycythaemia refers to raised haematocrit with normal red cell mass. plasma volume may be reduced. This condition is associated with acute hypoxia, smoking, alcohol and diuretics. We describe two life-threatening thrombotic events in two patients with relative polycythaemia under age 40 years. The first had myocardial infarction and on admission haemoglobin was 21.6 g dL-1. The second developed pulmonary embolism and haemoglobin was 19.1 g dL-1. Both patients received antithrombotic measures and isovolumetric venesection. Sixteen patients (age <40 years) who attended our accident and emergency department in 1 year had a haemoglobin level of >18.0 g dL-1. Recognition of relative polycythaemia in at risk-individuals may help reduce thrombotic risk.- - - - - - - - - - ranking = 1keywords = venesection (Clic here for more details about this article) |
8/38. EPO-producing gastric carcinoma in a hemodialysis patient.A case of erythrocytosis caused by gastric cancer that produced erythropoietin is described. To the authors' knowledge, no case of erythropoietin-producing gastric cancer has been reported until now. A 73-year-old man with a 4-year history of maintenance hemodialysis for diabetic nephropathy required phlebotomy. serum erythropoietin level was 181 mU/mL (181 IU/L). gastroscopy results showed rough mucosa with hemorrhaging caused by gastric cancer. The patient underwent distal gastrectomy, and serum erythropoietin level decreased to 27.1 mU/mL (27.1 IU/L) by postoperative day 8. Existence of erythropoietin in the tumor tissue was confirmed immunohistochemically. The presence of severe acquired cystic disease of the kidney, renal cell carcinoma, and other malignant tumors should be investigated in hemodialysis patients displaying erythrocytosis.- - - - - - - - - - ranking = 0.55145116011259keywords = phlebotomy (Clic here for more details about this article) |
9/38. Erythrocytosis associated with a placental-site trophoblastic tumor.We present a case of placental-site trophoblastic tumor associated with erythrocytosis. This 42-year-old woman had persistent amenorrhea and low elevations of her hCG titer after term delivery of a healthy female infant. The woman was noted to have polycythemia of uncertain etiology and was treated with serial phlebotomy. Placental-site trophoblastic tumor was diagnosed and hysterectomy was performed, with subsequent resolution of the polycythemia. Although erythrocytosis has been reported with other gynecologic tumors, this is the first reported association with a placental-site trophoblastic tumor. A role has been suggested for placental lactogen in erythropoiesis during pregnancy based on previous animal studies. Diffuse positive staining for hPL is characteristic of placental-site trophoblastic tumors. We postulate that hPL may have played an ancillary role to erythropoietin in the erythrocytosis demonstrated in this case. Spider angiomata and splenomegaly are interesting clinical features previously described in association with placental-site trophoblastic tumors, and were demonstrated in this patient.- - - - - - - - - - ranking = 0.55145116011259keywords = phlebotomy (Clic here for more details about this article) |
10/38. Familial and congenital polycythemia in three unrelated families.Three families with polycythemia inherited through apparently different modes are described. Secondary causes of polycythemia were ruled out. erythropoietin (EPO) levels were normal or low, even after phlebotomy. in vitro erythroid colony growth in standard assay cultures containing EPO was normal; however, in the absence of added EPO, a few progenitors from most of the affected individuals were able to generate recognizable colonies of mature erythroblasts, although these were smaller and proportionately less numerous than seen in polycythemia vera (PV). To search for EPO-receptor changes as a possible pathophysiologic mechanism, we examined, by Southern blot analysis, genomic dna samples from affected and nonaffected family members, as well as three patients with PV. Two different probes, derived from the human EPO-receptor, were used. We found no evidence for chromosomal rearrangements or gene amplification in hereditary polycythemia or PV patients. Further, no nucleotide sequences were found that were homologous to the Friend spleen focus-forming virus glycoprotein gp55, which has been shown to bind to and activate the murine EPO-receptor. Functional studies examining number and binding affinity of the EPO-receptor on erythroid progenitors from three hereditary polycythemia patients demonstrated no abnormalities. We conclude that the mechanism(s) for the erythrocytosis in familial and congenital polycythemia and in PV may not involve the EPO-receptor and, therefore, may result from alterations of postreceptor responses.- - - - - - - - - - ranking = 0.55145116011259keywords = phlebotomy (Clic here for more details about this article) |
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