Polycythemia

Several nonoccupational health problems have been traced to cobalt compounds. Cobalt compounds were used as foam stabilizers in many breweries throughout the world in the mid to late 1960s, and over 100 cases of cardiomyopathy, several followed by death, occurred in heavy beer drinkers (38,39). Those affected consumed as much as 6 L/d of beer (qv) and chronic alcoholism and poor diet may well have contributed to this disease. Some patients treated with cobalt(II) chloride for anemia have developed goiters and polycythemia (40). The impact of cobalt on the thyroid gland and blood has been observed (41). 

Mutations (eg, hemoglobin Chesapeake) that favor the R state increase O2 affinity. These hemoglobins therefore fail to deliver adequate O2 to peripheral tissues. The resulting tissue hypoxia leads to polycythemia, an increased concentration of erythrocytes. 

Venous stasis Major medical illness (e.g., congestive heart failure) Major surgery (e.g., general anesthesia for greater than 30 minutes) Paralysis (e.g., due to stroke or spinal cord injury) Polycythemia vera Obesity Varicose veins... 

General side effects of testosterone include gynecomastia, dyslipidemia, polycythemia, and acne. Weight gain,... 

Hydroxyurea is an oral drug that inhibits ribonucleotide reductase, which converts ribonucleotides into the deoxyribuon-cleotides used in DNA synthesis and repair. The time to peak concentrations of hydroxyurea is 1 to 2 hours after oral administration. Approximately 50% is degraded by the liver to form urea and respiratory carbon dioxide. The remainder is excreted by the kidney. The half-life ranges from 3.5 to 4.5 hours. Hydroxyurea has shown clinical activity in the treatment of chronic myelocytic leukemia, polycythemia vera, and thrombocytosis. The major side effects are myelo-suppression, nausea and vomiting, diarrhea, and constipation. Rash, mucositis, and renal tubular dysfunction occur rarely. 

Polycythemia A condition in which there is a net increase in the total circulating erythrocyte (red blood cell) mass of the body. 

Hydroxy urea (HU), a hydroxylated derivative of urea, has long been used in the treatment of various forms of neoplastic disorders such as polycythemia vera, head and neck cancer, chronic granulocytic leukemia, and more recently in sickle cell disease, / thalassemia and HIV infection [1],... 

The structurally related pan-JAK kinase inhibitor pyridone PI (15) has been evaluated in a mouse model of PV induced through the chronic administration of EPO. Administration of EPO (10 U/g) every other day for 5 days resulted in progressive polycythemia and splenomegaly. Administration of 15 at 100 mg/kg/day prevented EPO-induced... 

Venous stasis is slowed blood flow in the deep veins of the legs resulting from damage to venous valves, vessel obstruction, prolonged periods of immobility, or increased blood viscosity. Conditions associated with venous stasis include major medical illness (e.g., heart failure, myocardial infarction), major surgery, paralysis (e.g., stroke, spinal cord injury), polycythemia vera, obesity, or varicose veins. 

In an attempt further to elucidate the anhaptoglobinemia in patients with anemia, Nyman (N7) studied the plasma Hp in 335 cases of anemia (Hb less than 11 g/lOOml) mainly from a department of internal medicine. The partition she found (Table 2) is instructive from a pathophysiological point of view. The frequency of subnormal Hp values found within the different diagnostic groups may fairly well reflect the hemolytic trait in tire different types of anemia. Subnormal Hp possibly secondary to the increased red cell destruction is a common finding also in polycythemia. 

Hemoglobin (a) Trauma (b) Surgery Polycythemia Polycythemia (increase in Anemias... 

Intraurethral Urethral stricture balanitis severe hypospadias patients with acute or chronic urethritis thrombocythemia polycythemia. 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

Its primary indications are myeloproliferative disorders, including chronic granulocytic leukemia, polycythemia vera, and essential thrombocytosis. It is also used in combination with radiotherapy for head and neck cancer and for carcinoma of the cervix. Hydroxycarbamide is well absorbed after oral administration. It is in part metabolized in the liver and also excreted unchanged in the urine its elimination half-life is 2-5 hours. Its major toxicity consists of short lasting bone marrow depression. 

Campbell PJ, Green AR. Management of polycythemia vera and essential thrombocythemia. Hematology Am Soc Hematol Educ Program 2005 201-8. 

Pearson TC, Messinezy M, Westwood N, Green AR, Bench AJ, Green AR et al. Polycythemia vera updated diagnosis, pathobiology, and treatment. Hematology (Am Soc Hematol Educ Program) 2000 51-68. 

Allopurinol is especially indicated in the treatment of chronic tophaceous gout, since patients receiving it show a pronounced decrease in their serum and urinary uric acid levels. Because it does not depend on renal mechanisms for its efficacy, allopurinol is particularly beneficial for patients who already have developed renal uric acid stones, patients with excessively high urate excretion (e.g., above 1,200 mg in 24 hours), patients with a variety of blood disorders (e.g., leukemia, polycythemia vera), patients with excessive tophus deposition, and patients who fail to respond well to the uricosuric drugs. 

Polycythemia with high dosage Serious Reactions... 

Hematological system (anemia, polycythemia, thrombocytopenia, leukemia, lymphoma, multiple myeloma)... 

After oral administration, it is well absorbed and excreted in urine as methanesulfonic acid. It is mainly used in chronic myeloid leukaemia, polycythemia vera, essential thrombocythemia and myelofibrosis. 

It is indicated in treatment of chronic granulocytic leukaemia, polycythemia vera, essential thrombocytosis, melanoma. 

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