A transitory polycytaemia after parathyroidectomy for secondary hyperparathyroidism--a literature survey and a case...

The present study is a literature review of a nephrological problem--secondary hyperparathyroidism, its surgical treatment and the effect of the intervention on the anemic syndrome in patients with chronic renal failure (CRF) on hemodialysis treatment. We present a case of a 29-year-old female hemodialysis patient with a transitory polycytaemia (duration of 5 months) after parathyroidectomy for secondary hyperparathyroidism. Prior to surgery she was constantly anemic in spite of epoetin treatment lasting 10 years. Ten days after the parathyroidectomy there was a crucial decline of parathormone (from 900.4 pg/ ml to 21.4 pg/ml) and ionized calcium (iCa) (from 1.23 mmol/l to 0.79 mmol/l) and the hemoglobin level reached 170 g/l with a hematocrit of 0.53. After discontinuation of epoetin treatment (58.8 U/kg/week) in the following 5 months hemoglobin level declined reaching 144 g/l. Two years after parathyroidectomy the patient is still with normal hemoglobin level (125-135 g/l) without epoetin treatment. We discuss the likely mechanisms for the early onset of polycytaemia after parathyroidectomy as well as the importance of adequate control of secondary hyperparathyroidism in the management of anemia in chronic renal insufficiency.