Retrospective Study of High Hemoglobin Levels in 56 Young Adults

Abstract

Background: Erythrocytosis is a frequent request for consultation in the hematologic field. The diagnostic approach is well established in the general population but in a young adult, finding the etiology of erythrocytosis can be a real diagnostic challenge. Methods: This is an observational retrospective unicentric study made at the Sherbrooke University Hospital Center, over a period of 20 years (1995-2015). Every patient aged between 16 and 35 years old with a significant elevation of hemoglobin or hematocrit was included (hemoglobin > 185 g/L and/or hematocrit > 0.52 in men; hemoglobin > 165 g/L and/or hematocrit > 0.48 in women). Results: Totally, 426 patients met the inclusion criteria (over a total of 113,453 complete blood counts) but only 56 entered the study for investigations. The majority of patients were of male gender, 43% of the patients were obese, 59% were smokers and 38% used excess alcohol or recreational drugs. Twenty-five patients had the diagnosis of absolute erythrocytosis. Seven patients had the diagnosis of relative erythrocytosis and no cause could be identified in 24 patients. No primary erythrocytosis was found in this cohort. Among the 25 patients with secondary erythrocytosis, hypoxia was the most frequent etiology identified. Less than half of the patients in the cohort had long term follow-up. Search for JAK2 mutation and serum EPO dosage were performed in 17.9% and 23.2% of cases respectively. Seven patients were treated with aspirin and five patients had phlebotomies. Conclusions: This retrospective study reveals an actual clinical management that is often discordant with the current recommendations and a frequent lack of follow-up after initial investigations. Harmonization of management of erythrocytosis appears to be highly desirable.

Diagnosis and management of non-clonal erythrocytosis remains challenging: a single centre clinical experience

“…Erythrocytosis frequently represents a challenge for the physician. While PV management has been well established [ 24 ], non-clonal erythrocytosis attracts less interest in the clinical and scientific community [ 12 , 25 ]. Therefore, many JAK2 negative erythrocytosis patients with erythrocytosis and with no apparent secondary cause for erythrocytosis do not have an adequate follow-up.…”

“…It seems that patients with non-clonal erythrocytosis were not considered at high risk for complications and therefore were not referred for further investigations. It also seems that haematologists are less familiar or less interested in diagnostic algorithms of non-PV erythrocytosis and/or that non-clonal erythrocytosis is often trivialized [ 12 , 25 ].…”

“…It is important to be familiar with the contemporary evaluation of erythrocytosis, utilizing algorithms for efficient testing in the majority of patients in everyday clinical practice [2][3][4][5]11]. Whereas PV is almost always easily confirmed, other types of erythrocytosis are often less well recognized, weakly proven or even ignored [12][13][14][15][16].…”