nbme20/Block 2/Question#17

A 57-year old man has a hemoglobin concentration of ...

Chronic obstructive pulmonary disease

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submitted by hayayah(229),

This is reactive polycythemia vera, which is due to high altitude or lung disease. SaO2 is low, and EPO is increased.

Another way to approach the question is looking at the blood smear. It's pretty normal (no megakaryocytes, no increased number of platelets, no rods, nothing blue, etc). A blood smear from a COPD patient will be normal. Just an increased number of RBCs due to the increased EPO leading to increased Hgb.

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submitted by strugglebus(43),

Pt has polycythemia vera (myeloproliferative disorder) due to chronic hypoxia induced by COPD. Myeloid metaplasia is extra medullary hematopoiesis due to myelofibrosis. Hereditary hemochromatosis would have been proven by a prussian blue stain. Hypersplenism would have caused decreased RBCs, and myelodysplasic syndrome would have shown Auer rods or blasts.

neonem  Right, I think this would be just called "appropriate absolute polycythemia", whereas polycythemia vera is due to a malignant JAK2 mutation and would be termed a type of chronic myeloproliferative disorder. +