DEFINITION:

An increase in both the number of circulating erythrocytes, and the concentration of hemoglobin within the blood.

Types of Polycythemia

Polycythemia Vera

Secondary Polycythemia

Relative Polycythemia

Myeloproliferative Disease

A malignant overproduction of cells and takes place in the bone marrow.

Major Symptoms of
Polycythemia Vera

Relentless, unrestrained production of erythrocytes.

Production of excessive WBC’s and Over production of platelets.

Especially in late stages

Severe Consequences

An increase in the blood viscosity

An increase in the total blood volume

Severe blood congestion of all tissues and organs.

S&S of Polycythemia Vera

Ruddy complexion and dusky redness of mucosa

Hypertension

CHF

Thrombus Formations

CVA, MI and gangrene of the feet can result

More S&S

Bleeding and hemorrhage in the GI tract oropharynx and brain, especially following minor accidents or surgery.

Enlarged liver and spleen

Gout

Puritus after bathing

Lab findings of
Polycythemia Vera

Increased RBC count (8-12 million/mm3)

Increased Hgb (18 and over)

Increased Hct (35-60)

Increased WBC and Platelets (especially later in stages)

MCHC Decreased

Goals of treatment of Polycythemia Vera

To reduce blood viscosity

To reduce bone marrow activity

Intervention for
Polycythemia Vera

Phlebotomy

Uses of myelosuppresive agents

Activity

Fluid balance

Treatment of gouty Arthritis

Avoid Massage

Discourage smoking

Avoid emotional situations

Monitor VS closely

Avoid sodium rich foods

Avoid restriction of blood vessels in lower extremities

Nursing Interventions of Polycythemia Vera cont.

Force fluids to decrease blood viscosity

Administer anticoagulants as ordered

Assess Skin Color—Ruddy, cyanosis

Observe Pt. For pain SOB and Alterations in LOC

Inspect for blood in stools, urine emesis.

Nursing Interventions of Polycythemia Vera cont.

Observe for bleeding gums, nose, hemorrhoids

Inspect extremities for adequacy of circulation

Assess for signs of Thrombosis (redness, swelling, pain, tenderness in extremities)

Assess for S&S of TIA/CVA

Monitor lab and x-ray values closely

Secondary Polycythemia

Hypoxia that is sufficiently prolonged to cause polycythemia:

Results from

COPD (especially emphysema)

Congenital heart disease

Prolonged exposure to altitudes of 10,000 feet or more

S&S and lab findings

The same as with polycythemia vera

EXCEPT: the leukocyte increase does not occur

Treatment

Treat underlying cause or condition causing the hypoxia.

TX: Emphysema

TX: congenital heart disease

Move out of the mountains

Relative Polycythemia

Cause of relative polycythemia are fluid loss and dehydration

Insufficient fluid intake

Diarrhea

Vomiting

Burns

Excessive Administration of diuretics.

Without proper treatment ½ of patients with polycythemia die within 28 months. The major cause of death:

Thrombosis

Hemorrhage