Case 116 – Update 2!

Thank you for everyone’s contributions so far!

It has been noted that our patient who presented with an ischaemic stroke has a raised HCT and you have mentioned that we need to ensure this is an absolute polycythaemia and if so whether there is a primary or secondary cause.

To recap the FBC result taken at the time of his stroke was Hb 122, HCT 0.56, MCV 72, Plts 480, WCC 9.8, Neuts 7.5. NB we have repeated the FBC and th results are similar (lets not forget this!!)

Various information/investigations to determine the aetiology of his polycythaemia have been requested by yourselves as follows:

  • Current smoker: 5/day
  • Lives in the UK at sea level
  • PMH: renal transplant 6 months ago secondary to rapidly progressive glomerulonephritis. Native kidneys in situ. No prior CVA, diabetes, hypertension, or hypercholesterolaemia.
  • On examination: Saturations 99%. BP 139/68.
  • ECG: normal sinus rhythm.
  • Electrolytes normal. Ferritin 13. Albumin 37. Lipid profile unremarkable. Glucose NAD
  • JAK2 V617F, EPO levels pending.

 

The main differentials suggested are:

  • Primary polycythaemia
  • Polycythaemia post renal transplant

 

Questions:

  1. What further information from the patients history/examination would be useful to  help determine potential secondary causes of polycythaemia?
  2. What are the risk factors for polycythaemia post renal transplant? How would you treat it?

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