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The classification and diagnosis of erythrocytosis
M. F. MCMULLIN
INTRODUCTION
Definition of an erythrocytosis
Red cells make up the majority of cells in the blood
and as such influence the viscosity. Raised viscosity
may lead to pathology. An increase in the quantity
of red cells or red cell mass is therefore an erythrocytosis.
An elevated haemoglobin or haematocrit
(Hct) raises the possibility of an erythrocytosis. The
Hct reflects whole blood viscosity most accurately
(Pearson et al., 1981) but it can be underestimated
by some analysers in the presence of iron deficiency
(Guthrie & Pearson, 1982). An individual may have
an Hct above the normal range. The normal range
is defined and quoted as 0.45 ± 0.05 in males and
0.41 ± 0.05 in females and thus there will be variation
beyond this range which may or may not be
abnormal. An Hct >0.51 in a male and 0.48 in a
female is judged to be above the normal range and
thus elevated. To establish if there is a definite
increase in red cell mass as reflected by an elevated
haemoglobin/Hct a red cell mass can be measured.
This was previously expressed in terms of total body
weight (ml/kg) but this leads to low measured
values and high predicted normal values in the
obese as fat is relatively avascular. Therefore
measurements are related to formula for prediction
Department of Haematology, The
Queen’s University, Belfast, UK
Correspondence:
Prof. M. F. McMullin, Department
of Haematology, ‘C’ Floor, Belfast
City Hospital, Queen’s University
Belfast, Lisburn Road, Belfast
BT9 7AB, UK.
Tel.: +44 289 026 3732;
Fax: +44 289 026 3870;
E-mail: m.mcmullin@qub.ac.uk
doi:10.1111/j.1751-553X.2008.01102.x
Received 27 August 2008;
accepted for publication 27 August
2008
Keywords
Polycythaemia vera, erythrocytosis,
erythropoietin
SUMMARY
An absolute erythrocytosis is present when the red cell mass is
raised and the haematocrit is elevated above prescribed limits.
Causes of an absolute...

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