Secondary erythrocytosis (secondary polycythemia): causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Secondary erythrocytosis (secondary polycythemia) is erythrocytosis, which develops again due to the influence of other factors.
Frequent causes of secondary erythrocytosis are smoking, chronic arterial hypoxemia and tumor process (tumor-associated erythrocytosis). Less common are hemoglobinopathies with an increased affinity for hemoglobin to oxygen and other hereditary disorders.
In smoking patients, reversible erythrocytosis can be the result of tissue hypoxia caused by a rise in the concentration of carboxyhemoglobin in the blood, the level of erythrocytes is often normalized after cessation of smoking.
In patients with chronic hypoxemia [due to lung disease, intracardiac discharge of blood from right to left, with prolonged stay high above sea level or with hypoventilation syndromes], erythrocytosis frequently develops. The main method of treatment is the elimination of the underlying cause; in some cases, oxygen therapy can help. To reduce blood viscosity and alleviate symptoms, phlebotomy can be used.
Hemoglobinopathies with high hemoglobin affinity for oxygen are a rare pathology and occur in certain geographical areas. The diagnosis, as a rule, is suspected when collecting a family history (erythrocytosis in other relatives) and is confirmed by the determination of P 50 and, if possible, the construction of the complete dissociation curve of oxyhemoglobin. Standard hemoglobin electrophoresis is usually within the normal range and does not allow to reliably exclude this cause of erythrocytosis.
Tumor-associated erythrocytosis can be observed in tumors and cysts of the kidneys, hepatomas, hemangioblastomas of the cerebellum or uterine leiomyoma, secreting EPO. In patients with erythrocytosis, the level of serum EPO should be determined, and if the serum EPO is normal or elevated, CT of the abdominal cavity should be performed. Removal of the tumor can lead to a normalization of the level of red blood cells in the blood.
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