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Diagnostic approach to the patient with polycythemia

Ayalew Tefferi, MD
Section Editor
Stanley L Schrier, MD
Deputy Editor
Jennifer S Tirnauer, MD


Polycythemia is a laboratory finding in which there is an increased number of red blood cells (RBC), along with an accompanying increase in the concentration of hemoglobin in the peripheral blood [1]. This is documented via an abnormality in one or more of the following tests (see 'Laboratory testing' below):

Hematocrit – The hematocrit (HCT) is expressed as the percent of a blood sample occupied by intact RBC. Polycythemia in the adult patient is considered to be present when the HCT is >48 or >52 percent in women and men, respectively.

Hemoglobin concentration – The hemoglobin concentration (HGB) is expressed in grams per 100 mL of whole blood or in grams per liter of whole blood. Polycythemia in the adult is considered to be present when the HGB is >16.5 or >18.5 g/dL, or >165 or >185 g/L in women and men, respectively.

Red blood cell count – The red blood cell (RBC) count is expressed as the number of RBC per microL or liter of whole blood. The normal RBC count is approximately 5 x 106 cells per microL or 5 x 1012 cells per L. It is the least often used of the three tests to suggest polycythemia, since patients with thalassemia minor may have an elevated RBC count, but a reduced HCT or HGB due to the presence of an increased number of small (microcytic), poorly hemoglobinized (hypochromic) red cells.

The approach to the patient with an elevation in one or more of the above RBC parameters will be reviewed here. The approach to confirming a diagnosis of polycythemia vera is discussed separately. (See "Clinical manifestations and diagnosis of polycythemia vera".)


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Literature review current through: Sep 2016. | This topic last updated: Jul 18, 2016.
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