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[A 53-year-old man with headache and concentration difficulties]
Anders Vik1, Reidar Berntsen, Vidar Isaksen
1Medisinsk avdeling, Universitetssykehuset Nord-Norge, 9038 Tromsø. anders.vik@unn.no
Summary
Polycythaemia vera diagnosis can be complex. This case highlights that elevated erythropoietin levels, typically ruling out polycythaemia vera, may not always exclude the diagnosis in cases of extreme hemoconcentration.
Area of Science:
- Hematology
- Oncology
- Internal Medicine
Background:
- Polycythaemia vera is a myeloproliferative neoplasm lacking a single diagnostic marker.
- Diagnosis traditionally relies on major and minor criteria.
- Low serum erythropoietin is often considered a key diagnostic indicator.
Observation:
- A 53-year-old male presented with erythrocytosis, thrombocytosis, and leukocytosis.
- The patient exhibited extreme hemoconcentration with a packed cell volume of 0.68.
- Serum erythropoietin levels were elevated at 29.0 U/l, exceeding the normal range.
Findings:
- Despite elevated erythropoietin, the patient was diagnosed with polycythaemia vera.
- Treatment with venesection normalized hematocrit and resolved symptoms.
- Serum erythropoietin levels decreased to low normal values post-treatment.
Implications:
- Elevated erythropoietin does not definitively exclude polycythaemia vera, especially with hemoconcentration.
- Local renal hypoxia may contribute to elevated erythropoietin in some polycythaemia vera cases.
- Diagnostic approaches for polycythaemia vera may need to consider atypical presentations.