SHAQLAWA TECHNICALE INSTITUTE

DEPARTMENT OF NURSING

REPORT ABOUT:

POLYCYTHEMIA

PREPARED BY:
MUHAMMAD MAMA HUSAIN
SUPERVISED BY: MR. MUZAFAR B. AHMED

2019-2020
TABLE OF CONTENTENT
INTRODUCTION

Polycythemia is an abnormal increase in red blood cells. It happens

when the tissue inside your bones (bone marrow) makes too much
blood. It also can occur if your blood does not have enough liquid, or
plasma. This can make the number of red blood cells seem higher than
normal. The extra red blood cells make your blood thicker than normal.
This may raise your risk for blood clots that can cause heart attacks or
strokes. Clots can form in the deep veins of the body, a condition called
deep vein thrombosis. Or, a clot can travel through the blood to a lung
(a pulmonary embolism). https://stanfordhealthcare.org/medical-
conditions/cancer/polycythemia.html

Polycythemia can be divided into two categories: primary and

secondary.

Primary polycythemia: In primary polycythemia the increase in red

blood cells is caused by inherent problems in the process of red blood
cell production.

Secondary polycythemia: Secondary polycythemia generally occurs as a

response to other factors or underlying conditions that promote red
blood cell production.
What are the normal ranges for red blood cells?

Red blood cell count ranges

 Hematocrit is the ratio of the volume of red cells to the volume of

whole blood. The normal range for hematocrit varies between
sexes and is approximately 45% to 52% for men and 37% to 48%
for women. Hematocrit (HCT): Polycythemia is considered when
the hematocrit is greater than 48% in women and 52% in men.
 Hemoglobin is a protein in the red blood cells that carries oxygen
and gives blood its red color. The normal range for hemoglobin
may differ between the sexes and is approximately 13 to 18 grams
per deciliter for men and 12 to 16 grams per deciliter for women.
Hemoglobin (HGB): Polycythemia is considered when there is a
hemoglobin level of greater than 16.5g/dL in women or
hemoglobin level greater than18.5 g/dL in men.

https://www.medicinenet.com/polycythemia_high_red_blood_cell_co
unt/article.htm#what_causes_secondary_polycythemia

Symptoms
Polycythemia Symptoms

When there is an increased blood volume and viscosity (thickness),

complications associated with this disease can occur. The following are
the most common symptoms of polycythemia. However, each
individual may experience symptoms differently.
Symptoms may include:

 Fatigue and/or weakness

 Headache
 Dizziness
 Shortness of breath and difficulty breathing while lying down
 Visual disturbance, such as double vision, blurred vision, and blind
spots
 Inability to concentrate
 Night sweats
 Flushed complexion
 Nosebleeds
 Bleeding gums
 Excessive menstrual bleeding
 Hemoptysis (coughing up blood)
 Bruising
 Itchy skin (particularly after a hot bath)
 Gout
 Numbness
 High blood pressure (hypertension)
 Arterial or venous blood clots, considered the most serious
complications of polycythemia, can occur, resulting in a heart
attack, stroke, or pulmonary embolism. Liver and spleen
enlargement are other potential complications. The symptoms of
polycythemia may resemble other blood disorders or medical
problems. Always consult your doctor for a diagnosis.
https://stanfordhealthcare.org/medical-
conditions/cancer/polycythemia.html
What causes polycythemia?

The exact causes of polycythemia are not known. There is evidence,

however, that mutations (changes) in specific genes are related to the
development of the disease. These mutations occur during an
individual’s lifetime and are not passed on from parents to their
children. Only in very rare cases is polycythemia inherited.
https://www.healthgrades.com/right-care/blood-
conditions/polycythemia

There are two types of polycythemia, which have different causes.

Primary polycythemia

Primary polycythemia is also called polycythemia vera (PV).

PV is a rare, slow growing blood cancer that is a type of condition

known as a myeloproliferative neoplasm. PV causes the bone marrow
to create excess precursor blood cells that develop and function
abnormally, leading to the production of too many red blood cells.

A person with PV may also have increased numbers of other blood

cells, such as white blood cells or platelets.

https://www.medicinenet.com/polycythemia_high_red_blood_cell_co
unt/article.htm
Secondary polycythemia

Secondary polycythemia can occur if the increase in red blood cells is not due to
the myeloproliferative disease of PV.

The overproduction of blood cells in secondary polycythemia is limited to the red

blood cells.

Causes of secondary polycythemia include:

being at a very high altitude

obstructive sleep apnea

certain types of tumor

heart or lung disease that causes a low oxygen level in the body

https://www.medicalnewstoday.com/articles/polycythemia#summary

What are the risk factors for polycythemia

A number of factors increase the risk of developing polycythemia. Not all people
with risk factors will get polycythemia. Risk factors for polycythemia include:

 Age over 60 years

 Excessive smoking
 Male gender
 Prolonged exposure to low oxygen levels (such as due to smoking)

https://www.healthgrades.com/right-care/blood-conditions/polycythemia
Diagnosis
If doctors suspect that a person has polycythemia, they will order several tests to
help identify the underlying issue.

Blood tests

Blood tests, such as a complete blood count, will reveal any increase in red blood
cells in the bloodstream, as well as any abnormal levels of platelets and white
blood cells. If PV seems possible, a doctor will order more specific blood tests.

Bone marrow biopsy

If necessary, the doctor may also want to remove some bone marrow on which to
perform tests in a lab. A bone marrow biopsy involves taking a small sample of
the bone marrow with a needle for examination under a microscope.

Genetic tests

Although genetic causes of PV are more rare, doctors may also want to analyze
the person’s bone marrow for genetic mutations that have links to PV. They may
also recommend examining cells in the blood for JAK2 mutation.

https://www.medicalnewstoday.com/articles/polycythemia#summary

Treatments
Polycythemia Treatment

Specific treatment for polycythemia will be determined by your doctor based on:

 Your age, overall health, and medical history

 Extent of the disease
 Your tolerance for specific medications, procedures, or therapies
 Expectations for the course of the disease
  Your opinion or preference

Treatment may include:

Phlebotomy

A procedure that involves removing blood from the body. Initially this must be
done frequently, often every week, but once enough blood has been removed to
deplete the body's iron stores, necessary to make blood quickly, it does not need
to be done as often.

Certain medications, including chemotherapy

Phlebotomy may not remove platelets effectively so medications are the

treatment of choice if the platelets are dangerously high. The medicines help to
keep your bone marrow from making too many blood cells, and keep your blood
flow and blood thickness closer to normal.

Radiation therapy

Radiation can help suppress overactive bone marrow cells. This therapy helps
lower your red blood cell count and keeps your blood flow and blood thickness
closer to normal.

https://stanfordhealthcare.org/medical-conditions/cancer/polycythemia.html

Drugs to reduce blood cells

Sometimes, phlebotomy is not enough to control blood cell growth. Doctors may
then recommend myelosuppressive drugs to help control blood cell counts. These
drugs include hydroxyurea (Hydrea), which suppresses the bone marrow to keep
it from producing as many blood cells.

JAK2 inhibitors

In cases where a person does not respond well to other medications, doctors may
recommend drugs that inhibit the JAK2 enzyme, which the JAK2 gene is
responsible for producing. These include ruxolitinib (Jakafi)
Other medications
Doctors will also often recommend other drugs to help control symptoms. These
include aspirin and antihistamines. Taking low dose aspirin helps reduce the risk
of clotting in many people with PV, and it may also alleviate troubling symptoms,
such as headaches. Doctors may recommend antihistamine drugs

https://www.medicalnewstoday.com/articles/polycythemia#summary

Can you prevent polycythemia?

Polycythemia prevention

Polycythemia due to a secondary cause such as long-standing smoking or

exposure to carbon monoxide can be prevented by omitting these risks.

Reducing risk factors for heart failure -- such as, controlling high blood pressure
and diabetes mellitus -- can potentially reduce the risk of polycythemia.

Congenital and primary polycythemia disorders, however, are not preventable.

https://www.medicinenet.com/polycythemia_high_red_blood_cell_count/article.
htm#what_causes_secondary_polycythemia