Secondary polycythemia

In this condition the hypervolemic erythrocytosis, with a hematocrit of up to 0.65, benefits systemic oxygen transport and regional perfusion ( Ersiev..and...C┬žio 1984;

Hypoxemic patients, for example those with cyanotic congenital heart disease or chronic bronchitis with respiratory failure, may benefit from correction, by venesection, of hyperviscosity due to 'decompensated' erythrocytosis associated with a hematocrit above 0.65. This 'decompensation' process is poorly understood and so rational management is difficult, but in practice a hematocrit above 0.65 should be reduced to between 0.60 and 0.65 ( Rosove ei a/ 1986). High-dose diuretics reduce blood volume with transient increases in hematocrit which do not reflect plasma volume in the steady state. It is better to use angiotensin-converting enzyme inhibitors than diuretics for heart failure in patients with secondary polycythemia. When doubt arises regarding management of secondary polycythemia, blood volume measurement clarifies the basis of the increases in hematocrit and hemoglobin concentration, allowing rational therapeutic strategies to be used.

Of course, the basic treatment of secondary polycythemia is effective management of the hypoxemia due to cardiopulmonary disease or, very occasionally, the tumor of kidney, uterus, liver, or brain which leads to excessive erythrocytosis through inappropriate erythropoietin production.

Severe warnings should be given to patients discharged from the intensive care unit who may resume smoking. Heavy alcohol intake may also hazard the circulation through its effect of contracting the plasma volume. Excess alcohol intake has also been blamed for inadequate ventilation or overnight apnea, leading to rises in red cell volume, hematocrit, and blood viscosity (Moore-Gillon and .Pe,ars.9D 1986).

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