POLYCYTHEMI

PRESENTED BY:

PALARAN, NINA MAE C.

 What is Polycythemia?
• Polycythemia is an increased volume of red
blood cells (erythrocytes).
• The hematocrit is elevated by more than 55% in
men or more than 50% in women.
• It is classified as either primary or secondary.

Normal blood Polycythemia

smear
 POLYCYTHEMIA VERA (PRIMARY)

• Polycythemia vera, or primary polycythemia,

is a proliferative disorder of the myeloid stem
cells.
• The bone marrow is hypercellular, and the
erythrocyte, leukocyte, and platelet counts in
the peripheral blood are elevated.
 SECONDARY POLYCYTHEMIA

• It is caused by an excessive production of

erythropoietin.
• This may occur in response to a reduced amount of
oxygen, which acts as a hypoxic stimulus, as in
cigarette smoking, COPD, or cyanotic heart disease, or
in non pathologic conditions such as living at a high
altitude.
• Can also occur as a result from certain
hemoglobinopathies or neoplasm, such as renal cell
carcinoma.
 CLINICAL MANIFESTATIONS
• Patients typically have a ruddy complexion and
splenomegaly.
• Symptoms results from increased blood volume (e.g
Headache, dizziness, tinnitus, fatigue, paresthesias, and
blurred vision)
• Increased blood viscocity (e.g Angina, claudication,
dyspnea, and thrombophlebitis, embolism)
• Blood pressure and uric acid are often elevated
• Generalized pruritus
• Erythromelalgia (a burning sensation in the fingers and
toes)
 Complications

• Risk for Thrombosis

- Cerebrovascular accident(CVA) - Brain Attack
& Stroke
- Myocardial Infarction
• Bleeding
 Diagnostic Procedure
• Blood test (Complete Blood
Count)
• Bone marrow aspiration or biopsy
• Specific gene testing
 Medical Management

1. Periodic
Phlebotomy
- to reduce blood viscosity
and deplete iron stores
- Done to remove extra red
blood cells from the blood
(500ml once or twice
weekly)
 Pharmacologic Management
1. Chemotherapeutic agents (e.g.hydroxyurea)
- are used to suppress marrow function (may increase risk
for leukemia).

2. Anagrelide (Agrylin)
- used to inhibit platelet aggregation and control the
thrombocytosis related to polycythemia.

3. Interferon alpha-2b (Intron-A)

- most effective treatment for managing the pruritus
associated with polycythemia vera.
 Pharmacologic Management
4. Antihistamines
- administered to control pruritus

5. Allopurinol
- used to prevent gouty attacks when the uric acid level is
elevated.
 NURSING MANAGEMENT
• Assess risk factors for thrombotic complications and
teach patient to recognize signs and symptoms of
thrombosis.
• Discourage sedentary behavior, crossing the legs,
and wearing tight or restrictive clothing (particularly
stockings) to reduce the likelihood of DVT.
• Advise patient to avoid aspirin and medications
containing aspirin (if patient has a history of
bleeding).
 NURSING MANAGEMENT
• Suggest a cool or tepid bath for pruritus, along
with cocoa butter–based lotions and bath
products to relieve itching or a sodium
bicarbonate dissolved in water.
• Advise patient to minimize alcohol intake and
avoid iron and vitamins containing iron.
• Advise patient to aat well-balanced meals
complete with fresh fruits and vegetables,
whole grains, lean protein, and low-fat dairy.
 Reference

● Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010).

Brunner and Suddarth’s textbook of medical-surgical nursing
(12th ed.). Philadelphia: Lippincott Williams & Wilkins.

● https://www.cancer.gov/publications/dictionaries/cancer-
terms/def/phlebotomy#:~:text=(fleh%2DBAH%2Dtoh
%2D,called%20blood%20draw%20and%20venipuncture.

● https://www.slideshare.net/rumanahameed1/polycythemia-vera-
rumana

● https://www.mayoclinic.org/diseases-conditions/polycythemia-
vera/diagnosis-treatment/drc-20355855
THANK YOU