We are discussing a case of polycythaemia. When finding polycyhthaemia (or erythrocytosis) it is important to think about the causes logically.  Here is a way of classifying the disorder:

As haematologists we are most worried about polycythaemia vera as there is an evidence-based treatment strategy in order to reduce thrombotic events and it is theoretically classified as a neoplasm (one of the myeloproliferative neoplasms).

Blood films are often useful in haematological disorders but as our followers have stated it is often not useful in polycthaemia as there are no specific findings and the red cells often become smudged due to the high haemtocrit.

Our patient has normal renal and liver function except for a slightly elevated GGT. He has cardiac troponins which are negative and ECGs do not show acute ischaemia. He is started on a beta blocker for angina pectoris and and outpatient cardiology review is arranged.

Questions:

• Name some investigations that would help take the case forward (hint – they may have already been mentioned earlier on!)
• Whilst waiting for investigations how would you manage this patient now?

Please reply on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.