The red blood cell count and the erythrocyte sedimentation rate in the diagnosis of polycythaemia vera.

Abstract

Iron deficiency in polycythaemia vera (PV) may impact the validity of the haematocrit (HCT), since HCT is red blood cell count (RBC) × mean corpuscular volume (MCV). To investigate (a) the effect of microcytosis on HCT, (b) the erythrocyte sedimentation rate (ESR) as a possible additional diagnostic marker for PV. This study included 182 subjects: 39 with PV, 27 with essential thrombocythemia (ET) and 116 suspected of myeloproliferative neoplasm (MPN) with a secondary cause for either thrombocytosis or erythrocytosis. Patients with PV had significantly lower ratio of MCV and serum ferritin compared to MPN suspects. A good correlation of RBC versus HCT was found for PV and MPN subjects when individuals with microcytosis were excluded (R2 =.87 in PV and R2 =.82 in MPN suspects). We found a specificity of 98% and a sensitivity of 37% for ESR <2mm in the diagnosis of PV. The RBC may more precisely reflect the total red cell mass and accordingly the hypercoagulable state of the PV patient, which is integrated in the ESR. A combination of RBC and ESR is proposed as a novel tool to substitute the Hb concentration and the HCT in the diagnosis of PV.