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POLYCYTHEMIA

(Primary & Secondary)
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Definition of POLYCYTHEMIA
• It is the production and presence of
increased numbers of RBCs. The increase
in RBCs can be so great that blood
circulation is impaired as a result of
hyperviscosity and hypervolemia.

Etiology &
Pathophysiology
Types of Polycythemia:
1. Primary Polycythemia/Polycythemia Vera
2. Secondary Polycythemia

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Primary Polycythemia
• Or Polycythemia Vera also known as
erythremia.
• Myeloproliferative disorder
• develops in clients > 50 y/o
• Splenomegaly
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Secondary Polycythemia
• Causes chronic hypoxia

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Clinical Manifestations and
Complications

• HPN
Subjective complaints: Headache, vertigo,
dizziness, tinnitus and visual
disturbances.
• experience angina, CHF, intermittent
claudication and thrombophlebitis
• Stroke
• Generalized pruritus
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• Hemmorhage
• ecchymoses, epistaxis or GI bleeding
• Splenomegaly and hepatomegaly-
complaints of satiety and fullness
• experience pain from peptic ulcer
• Plethora
• Hyperuricemia

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Diagnostic Studies

1. Elevated hgb and RBC count;
2. Elevated WBC count with basophilia;
3. Elevated platelets (thrombocytosis) and
platelet dysfunction;
4. Elevated leukocyte alkaline phosphatase,
uric acid and cobalamin levels; and
5. Elevated histamine levels. Splenomegaly
is found in 90% clients with primary
polycythemia but does not accompany
secondary polycythemia.

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Collaborative Care

• Phlebotomy
• Hydration therapy
• Myelosuppressive agents (busulfan
(Myleran), hydroxyurea (Hydrea))
• Allopurinol (Purinol)
• Antiplatelet agents (aspirin and
dipyridamole (Persantine))
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Nursing Management :
Polycythemia Vera

• maintaining adequate oxygenation may
prevent problems
• controlling chronic pulmonary disease,
stopping smoking, and avoiding high
altitudes
• the nurse may either assist with or perform
the phlebotomy
• Fluid intake and output must be evaluated
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• myelosuppressive agents are used,
observe the client, and teach the client
about the med side effect.
• Assessments of the client’s nutritional
status
• Activities
• Active or passive leg exercises and
ambulation
• Phlebotomy may need to be done every 2
or 3 months
• nurse must evaluate the client for the
development of complications.

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Problems of Hemostasis

• The homoestatic process involves the
vascular endothelium, platelets and
coagulation factors, which normally
function together to arrest hemorrhage
and repair vascular injury. Disruption in
any of these components may result in
bleeding or thrombotic disorders.

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3 major disorders of hemostasis:

• Thrombocytopenia (low platelet count)
• Hemophilia and von Willebrand’s disease
(inherited disorders of specific clotting
factors) and
• Disseminated intravascular coagulation
(DIC).

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