Polycythemia vera masked due to severe iron deficiency anemia

Kambali, Shweta; Taj, Asma

doi:10.1016/j.hemonc.2016.08.007

Cited by 14 publications

(13 citation statements)

References 11 publications

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“…[6][7][8] The red blood cell count (RBC) may be underutilized. 9 In addition, iron deficiency may raise suspicion for PV, 10 and the role of EPO warrants further investigation. 11,12 Key clinical parameters include smoking history and body mass index (BMI); the latter is often associated with obstructive sleep apnea (OSA).…”

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confidence: 99%

Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera

Shaw

Berg

2019

Clin Med Res

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Background: World Health Organization (WHO) 2017 diagnostic criteria for hemoglobin levels in polycythemia vera (PV) were lowered from 185 g/L to 165 g/L for men and from 165 g/L to 160 g/L for women, but these cutoffs were not designed for screening. Objectives: The primary aim of this study was to assess the value of laboratory and clinical parameters in deciding whether to further pursue a diagnosis of PV. A secondary aim was to explore the diagnostic utility of bone marrow morphology. Methods: We evaluated clinical and laboratory parameters that may be useful when considering further diagnostic work-up, emphasizing PV vs. secondary erythrocytosis (SE). We classified 200 patients with JAK2 V617F testing using WHO criteria. Results: Patients with myeloproliferative neoplasms (MPN) were rarely under age 40 and uncommonly obese (BMI ≥ 30 kg/m 2). Current smoking history favored SE, and these patients rarely had a platelet count ≥ 450 x 10 3 /uL. Laboratory parameters suggesting greater PV likelihood were: RBC > 6.8 x 10 6 for men or > 5.9 x 10 6 for women; low erythropoietin; and low MCV or low ferritin. Bone marrow morphology (available in 111 cases) was generally more cellular in PV vs. SE and assessed disease progression. Conclusions: Readily accessible clinical and laboratory data can assist in considering a PV workup, and a possible diagnostic algorithm is presented. These preliminary findings warrant larger studies to develop a more formal PV-risk scoring system with optimal cutoffs and weighting.

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confidence: 99%

Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera

Shaw

Berg

2019

Clin Med Res

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“…Some authors previously hypothesized that mPV could be a consequence of iron deficiency in PV patients. 12 Despite thrombocythemic patient MCV was in the normal range and not different from true PV patients, we can not totally exclude in this study that the platelet increase observed for these patients could be related, at least in some cases, to iron deficiency since ferritin level was not measured systematically for all patients. However, our findings are not in favor of this hypothesis since MCV level were not lower in mPV compared to true PV.…”

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confidence: 59%

Masked polycythemia vera: analysis of a single center cohort of 2480 red cell masses

et al. 2019

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“…The hemolytic process was probably responsible for normal Hb and Ht levels and normal RCV. Although masked PV due to an iron deficiency are well‐known, masked PV due to hemolysis are uncommon and this association could be undiagnosed or misdiagnosed with another MPN. Nevertheless, a differential diagnosis between early phases of PV, ET, and PMF is necessary because of their differences according to prognosis and therapeutic management .…”

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confidence: 99%