Polycythemia: secondary
Introduction
- Cause: pathological or physiological response.
- Signs: bleeding or often neurological.
- Diagnosis: hematology, erythropoietin assay.
- Treatment: manage underlying cause if physiological or chemotherapy if neoplastic.
- Prognosis: reasonable; good if can eliminate underlying problem.
Presenting signs
- Seizures Seizures.
- Blindness Blindness.
- Polyuria/polydipsia Polyuria/polydipsia (PU/PD).
Acute presentation
- Signs associated with thromboembolism, ie dyspnea (pulmonary) Lung: pulmonary thromboembolism.
Cost considerations
- Moderate expenses incurred in diagnosis and treatment.
Special risks
- Surgery:
-
- Thromboembolism at surgery due to further sludging of blood with reduced circulation.
- Excessive hemorrhage.
It is advisable to perform phlebotomy prior to surgery to reduce PCV.
Pathogenesis
Etiology
- Polycythemia can be classified as:
- Relative, ie normal red cell mass but PCV Hematology: packed cell volume increased due to reduced plasma volume.
- Absolute, ie increased PCV Hematology: packed cell volume , red cell mass and [hemoglobin]:
- Primary, iepolycythemia rubra vera Polycythemia: primary a rare myeloproliferative disorder (abnormal proliferation of erythroid precursors in bone marrow that occurs independent of erythropoietin).
- Secondary (erythropoietin-mediated erythropoiesis): physiological, pathological.
Specific
- Physiological:
- Chronic pulmonary disease.
- Right to left shunts.
- High altitudes.
- Pathological:
-
- Renal disease:
-
- Renal cysts Kidney: polycystic disease.
- Hydronephrosis Hydronephrosis / hydroureter.
- Tumors producing erythropoietin like substances:
-
- Renal carcinoma Kidney: neoplasia.
- Hepatoma Liver: neoplasia.
- Pheochromocytoma Pheochromocytoma.
- Ovarian carcinoma.
- Uterine leiomyoma.
- Adrenal adenoma/carcinoma (or hyperplasia).
Pathophysiology
- Increased packed cell volume (PCV Hematology: packed cell volume ) results in hyperviscosity → clinical signs.
- In a normal animal:
- Erythropoietin (produced by the kidneys) stimulates proliferation of red cell precursors in bone marrow → increased production of red blood cells.
- Erythropoietin produced in response to tissue hypoxia (physiological) → renal oxygen sensors → increased production and secretion of erythropoietin → increased red cell mass.
- Pathological polycythemia:
- Primary polycythemia Polycythemia: primary: autonomous clonal expansion of red cell precursors in bone marrow (myeloproliferative disease).
- Secondary polycythemia:
- Production of erythropoietin-like substance by tumor which continually stimulates red cell production.
- Functional renal neoplasia producing erythropoietin free from negative feedback mechanisms.
Timecourse
- Weeks to months.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Moore K W & Stepien R L (2001) Hydroxyurea for Treatment of Polycythemia Secondary to Right‐to‐Left Shunting Patent Ductus Arteriosus in 4 Dogs. JVIM 15, 418-421 PubMed.
- Crow S E et al (1995) Concurrent renal adenocarcinoma and polycythemia in a dog. JAAHA 31 (1), 29-33 PubMed.
- Quesnel A D & Kruth S A (1992) Polycythemia vera and glomerulonephritis in a dog. Can Vet J 33 (10), 671-672 PubMed.
- Campbell K L (1990) Diagnosis and management of polycythemia in dogs. Comp Cont Ed Pract Vet 12 (4), 543-550 VetMedResource.
- Waters D J & Preuter J C (1986) Secondary polycythemia associated with renal disease in the dog 2 case reports and review of the literature. JAAHA 24 (1), 109-114 VetMedResource.
- McGrath C J, Krawiec D R & Johnston S D (1982) Canine polycythemia vera, a review of diagnostic features. Vet Med 77 (4), 611-613 VetMedResource.
Other sources of information
- Hasler A H, Giger U (2000)Polycythemia.In:Textbook of Veterinary Internal Medicine. 5th edn. Eds: Ettinger S J & Feldman E C. W B Saunders, Philadelphia. pp 203-206.