Successful Use of Phlebotomy to Treat Severe Secondary Polycythemia Due to Chronic Lung Disease

Jacob Fuqua,Josephine Reece,Sarah Sofka

doi:10.4081/hr.2021.8961

Abstract

Secondary polycythemia (SP) occurs as a result of increase erythropoietin levels most commonly as a result of tissue hypoxia. Symptoms such as erythromelalgia, pruritis, and bleeding, which are frequently seen in polycythemia vera (PV), do not commonly occur in SP. Phlebotomy is considered one of the mainstays of therapy for PV but is rarely used for treatment of SP due to concern about worsening tissue hypoxia. We present the case of a patient with severe SP due to chronic hypoxic lung disease who presented with erythromelalgia, pruritis, and bleeding and was treated successfully with therapeutic phlebotomy. This case illustrates the importance of considering the use of therapeutic phlebotomy in symptomatic patients with severe SP.

Highlights

We present the case of a patient e with severe Secondary polycythemia (SP) due to chronic hypoxic lung s disease who presented with erythromelalgia, pruritis, and bleeding and was treated u successfully with therapeutic phlebotomy. l This case illustrates the importance of conia sidering the use of therapeutic phlebotomy c in symptomatic patients with severe SP. er Introduction m Phlebotomy, known as blood-letm ting or venesection, has been used for over five millennia to treat a multitude of illnesso es
Erythromelalgia and mal platelet count, and no evidence of to have symptoms of hyperviscosity and LUQ pain improved immediately after genetic mutations along with an obvious significant hypoxia requiring high amounts phlebotomy was initiated but his oxygen requirement did not decline until hospital ly day 6
Using the general rule that a normal O2ER is around 25% at rest, calculation of O2ER may be beneficial to ensure that phlebotomy is not overly reducing oxygen delivery to tissue which could result in further hypoxic complications

Summary

Introduction

We present the case of a patient e with severe SP due to chronic hypoxic lung s disease who presented with erythromelalgia, pruritis, and bleeding and was treated u successfully with therapeutic phlebotomy. He was given ASA 81 mg vascular disease, stroke, and arterial or chest with intravenous contrast (IV) showed daily, budesonide 80 mcg-formoterol 4.5 venous thromboembolism.[2] Secondary no evidence of a pulmonary embolism or mcg inhaled twice daily, ipratropium 0.5 polycythemia (SP) is a similar entity but aortic dissection but noted underlying bul- mg-albuterol 3mg by nebulization four occurs as a result of increased erythropoi- lous emphysema with prominent interstitial times daily as needed for shortness of etin (EPO) levels.

Results

Conclusion