The legacy of this great resource continues as the MSD Manual outside of North America. Common causes of secondary erythrocytosis include Abstract 4978. Medications 6. The term polycythemia is used appropriately in the myeloproliferative disorder called polycythemia vera, in which there are elevated levels of all three peripheral blood cell linesRBCs, … Description Polycythemia means too many red blood cells. Erythropoietin (EPO), a large (193 amino acid residue) glycoprotein hormone secreted by the kidney, regulates red blood cell (RBC) production. Secondary polycythemia is also called secondary erythrocytosis. Abstract 4978. Secondary polycythemia, as occurred in the present case, is caused by an increased serum erythropoietin level. Describes reference intervals and additional information for interpretation of test results. An aid in distinguishing between primary and secondary polycythemia, Differentiating between appropriate secondary polycythemia (eg, high-altitude living, pulmonary disease, tobacco use) and inappropriate secondary polycythemia (eg, tumors), Identifying candidates for erythropoietin (EPO) replacement therapy (eg, those with chronic renal failure), Evaluating patients undergoing EPO replacement therapy who demonstrate an inadequate hematopoietic response. Patients with elevated erythropoietin levels (and no indication of hypoxia) or microscopic hematuria should undergo abdominal imaging, central nervous system imaging, or both to seek a renal lesion or other tumor sources of erythropoietin. Injuries 4. Patients in chronic kidney failure, as well as patients with anemia due to a variety of other causes including chemotherapy, HIV/AIDS, and some hematologic disorders, may be candidates for treatment with recombinant human EPO. Hypoxia stimulates EPO release, which, in turn, stimulates bone marrow erythrocyte production. The most common causes of secondary polycythemia include obstructive sleep apnea, obesity hypoventilation syndrome, and chronic obstructive pulmonary disease (COPD). An EPO level <1.4 IU/L is 100% specific for a diagnosis of PV, while an EPO level of >13.7 IU/L is 100% specific for the diagnosis of secondary polycythemia. JAK2-V617F mutation compared to only 1.47% (n ¼ 2) whose primary diagnosis was secondary polycythemia. 2011 March;1(3). Also the total percentage of anemia in COPD patients was 46.3% (19/41), in comparison to … Some tumors secrete EPO or EPO-like proteins; examples include tumors of the kidney, liver, lung, and brain. In patients who smoke, reversible erythrocytosis results mainly from tissue hypoxia due to elevation of blood carboxyhemoglobin concentration; levels will normalize with smoking cessation. Removal of the lesion is curative. This assay cannot distinguish between endogenous and exogenous EPO. 1. Tefferi A: Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. Polycythemia with Renal Cell Carcinoma and Normal Erythropoietin Level. Results: A large majority of PV patients (87% or 101/116) had a serum Epo level below the normal range in healthy patients (3.3 IU/L), giving this value a specificity of 97% with a 97.8% positive predictive value for the diagnosis of PV. Medicine. Mayo Clin Proc. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. A low serum-erythropoietin (S-epo) level is a minor criterion of the World Health Organization (WHO) recommendations for diagnosing polycythemia vera (PV) even though previous studies indicate that a normal level does not always rule out PV. Appropriate secondary polycythemias (eg, high-altitude living and pulmonary disease) are characterized by hypoxia and a compensatory increase in red cell mass. Thus, patients who are anephric have a residual amount of EPO produced by the liver. Physicians may also measure the levels of erythropoietin (EPO), a hormone that causes the bone marrow to produce red blood cells. Additional specimen workup to eliminate heterophile antibody interference can be performed; call 800-533-1710 for additional information. Controversies exist regarding the diagnostic value of a low EPO level when considering increasing availability of advanced molecular testing. In secondary polycythemia, 6 to 8 million and occasionally 9 million erythrocytes may occur per cubic millimeter of blood. 1 People living at high altitudes may have higher EPO levels than people living at lower altitudes. There are no specific assays for measuring recombinant EPO compounds. METHODS: sEpo was assessed in 190 patients with polycythemia of different etiologies. Author information: (1)Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA. Evidence used in this review. Polycythemia with Renal Cell Carcinoma and Normal Erythropoietin Level. In primary polycythemia, your red blood cell … When comparing JAK2-V617 mutation to the EPO level, the area under the curve of JAK2-V617 (0.8970) was statistically larger than that of EPO test (0.6765). High oxygen–affinity hemoglobinopathies are very rare. Tests done when isolated erythrocytosis is present include, P50 to rule out a high oxygen-affinity hemoglobinopathy. Clinical Signs With relative polycythemia, vomiting or diarrhea may be pres- Secondary polycythemia is caused by either natural or artificial increases in the production of erythropoietin, hence an increased production of erythrocytes. The following algorithms are available in Special Instructions: -Erythrocytosis Evaluation Testing Algorithm, -Myeloproliferative Neoplasm: A Diagnostic Approach to Bone Marrow Evaluation, -Myeloproliferative Neoplasm: A Diagnostic Approach to Peripheral Blood Evaluation. Fisher JW: Erythropoietin: physiology and pharmacology update. Treatments 5. Therefore, chronic kidney failure may result in decreased EPO production and, subsequently, anemia. Kopel J(1), Sharma P(2), Warriach I(3), Swarup S(4). 1 Erythrocytosis has been defined as a greater than two standard deviation-increase from the age-, sex- and race-adjusted norm in hematocrit or hemoglobin level. erythropoietin is a hormone that tells your bone marrow to make new blood cells. In secondary polycythemia, the number of red blood cells (RBCs) is increased as a result of an underlying condition. (2)Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA. Past illnesses 3. a very low level can be another sign of polycythemia vera. Erythropoietin (EPO) levels alone cannot reliably distinguish between primary and secondary polycythemia; EPO levels are within normal limits in some patients with primary polycythemia. (2)Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA. Secondary polycythemia would more accurately be called secondary erythrocytosis or erythrocythemia, as those terms specifically denote increased red blood cells. People living at high altitudes may have higher EPO levels than people living at lower altitudes. Mossuz et al, found that the EPO level in cases of PV ranged between 0.6 to 13.7 IU/L (normal 3.3-13.7) compared with 3.3 to 33.9 IU/L of secondary polycythemia patients.8Only 87% of PV patients had the EPO level below the normal range, and the low EPO level had 97% specificity and 97.8% positive predictive value for diagnosing PV. The trusted provider of medical information since 1899, Reactive Thrombocytosis (Secondary Thrombocythemia). A low erythropoietin (EPO) level is a minor diagnostic criterion for polycythemia vera (PV). The diurnal variation is minimal in normal individuals (<20%), but in hospitalized patients with a variety of illnesses, as well as ambulatory patients with chronic lung disease, serum EPO concentrations can be 20% to 60% higher at night than early in the morning. Despite the newly-diagnosed polycythemia, the patient denied any significant symptoms or history of blood clots. High blood levels of RBC, hemoglobin, hematocrit, or oxygen suppress the release of EPO. Suggests clinical disorders or settings where the test may be helpful. Hoagland HC: Myelodysplastic (preleukemia) syndromes: the bone marrow factory failure problem. Nephrol Dial Transplant. Secondary erythrocytosis. Because in some cases the elevated hematocrit is physiologic, phlebotomy should be limited to the extent necessary to relieve symptoms (in contrast to polycythemia vera, where the goal is to normalize the hematocrit). For optimal results in serial patient monitoring, all specimens should be collected at the same time of day. Cardiovascular risk factors 2. Low erythropoietin (EPO) level may have only moderate predictive accuracy for polycythemia vera (PV), according to study results published in Blood Cells, Molecules and Diseases.. Low EPO level can be used to diagnose PV, but there has been debate over its diagnostic value in light of the increasing availability of advanced molecular testing. A total of 80.88% (n = 351) of those diagnosed with PV had a JAK2-V617F mutation compared to only 1.47% (n = 2) whose primary diagnosis was secondary polycythemia. RESULTS: sEpo levels were higher in SP than in PV and relative polycythemia. The term ‘erythrocytosis’ is derived from Greek words meaning ‘too many red cells’ and should be distinguished from ‘polycythemia’, meaning ‘too many cells in the blood’. Learn more about our commitment to Global Medical Knowledge. In the appropriate clinical setting (eg, confirmed elevation of hemoglobin >18.5 g/dL, persistent leukocytosis, persistent thrombocytosis, unusual thrombosis, splenomegaly, and erythromelalgia), polycythemia vera is unlikely when erythropoietin (EPO) levels are elevated but is likely when EPO levels are suppressed. Low erythropoietin (EPO) level may have only moderate predictive accuracy for polycythemia vera (PV), according to study results published in Blood Cells, Molecules and Diseases. Primary polycythemia (polycythemia vera) is a neoplastic (clonal) blood disorder characterized by autonomous production of hematopoietic cells. Provides information to assist in interpretation of the test results, Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances, Recommendations for in-depth reading of a clinical nature, Library of PDFs including pertinent information and forms related to the test, Customized Instructions & Shipping Guides, Erythrocytosis Evaluation Testing Algorithm, Myeloproliferative Neoplasm: A Diagnostic Approach to Bone Marrow Evaluation, Myeloproliferative Neoplasm: A Diagnostic Approach to Peripheral Blood Evaluation. Introduction. Patients, who have either a poor or no erythropoietic response to EPO therapy, but high-normal or high EPO levels, may have additional, unrecognized causes for their anemia. Conversely, an EPO level >3.3 IU/L has a sensitivity of 97% for detecting secondary polycythemia. This hormone, which is possibly produced and secreted by the kidneys, stimulates bone marrow production of RBCs. Drug levels can only be roughly estimated from the cross reactivity of the compounds in EPO assays. This diagnosis is suggested by a family history of erythrocytosis; it is established by measuring the P50 (the partial pressure of oxygen at which hemoglobin becomes 50% saturated) and, if possible, determining the complete oxyhemoglobin dissociation curve. Please confirm that you are a health care professional. If polycythemia vera is suspected, the patient should be evaluated as for polycythemia vera. 2 It is clear, however, … Secondary polycythemia may also be caused by increased levels of erythropoietin, a hormone that stimulates RBC produc-tion. Darbepoetin alpha is a 165 amino acid glycoprotein that is also produced in mammalian cells. Tumor-associated erythrocytosis can occur when renal tumors, cysts, hepatomas, cerebellar hemangioblastomas, or uterine leiomyomas secrete erythropoietin. This phenomenon is most pronounced in patients with EPO levels within approximately 2-times the upper limit of the normal population reference interval. 1995;70:673-677, 3. The condition may occur at high altitudes or, rarely, because of a tumor that releases erythropoietin. Am J Hematol. Secondary polycythemia may also be caused by increased levels of erythropoietin, a hormone that stimulates RBC produc-tion. Standard hemoglobin electrophoresis may be normal and cannot reliably exclude this cause of erythrocytosis. In tumors secreting erythropoietin, the EPO levels may be abnormally high. 2006 Oct 18;(4):CD003967, 6. Testing for the JAK2 V617F mutation and an erythropoietin (EPO) level helps differentiate secondary polycythemia from polycythemia vera. Secondary polycythemia, as occurred in the present case, is caused by an increased serum erythropoietin level. People living at high altitudes may have higher EPO levels than people living at lower altitudes. Patients with hypergammaglobulinemia associated with multiple myeloma or Waldenstrom disease have impaired production of EPO in relation to hemoglobin concentration. In addition to the kidneys, the liver also produces a small amount of EPO. A… The majority of EPO production is in the kidneys. Showed that the erythropoietin level was 15.24 ± 2.6 in stage 1, 22.61 ± 5.68 in stage 2, 33.59 ± 4, in stage 3, then 17.9 ± 3.3 in stage 4. Heterophile antibodies may interfere in this assay. In individuals with polycythemia vera, EPO levels are abnormally low. Any elevation of hemoglobin or hematocrit above normal values for age and sex is considered erythrocytosis. If JAK2 V617F mutation testing is negative but the EPO level is low, then testing for other mutations in exon 12 and 13 of JAK2 helps identify a small minority of patients with polycythemia vera. An elevated erythropoietin (EPO) level, usually as a secondary response to chronic hypoxemia, leads to secondary polycythemia. Controversies exist regarding the diagnostic value of a low EPO level when considering increasing availability of advanced molecular testing. It has 3 oligosaccharide chains and a molecular mass of 30.4 kDa. An elevated erythropoietin (EPO) level, usually as a secondary response to chronic hypoxemia, leads to secondary polycythemia. Because results obtained with one commercial EPO assay may differ significantly from those obtained with any other, it is recommended that any serial testing performed on the same patient over time should be performed with the same commercial EPO test. Strippoli GFM, Manno C, Schena FP, Craig JC: Haemoglobin and haematocrit targets for the anaemia of chronic kidney disease. In secondary erythrocytosis, only red blood cells (RBCs) are increased, whereas in polycythemia vera, RBCs, white blood cells (WBCs), and platelets will usually be increased. Spurious erythrocytosis may occur with hemoconcentration (eg, due to burns, diarrhea, or diuretic use). The increased production may be an appropriate (compensatory) physiologic response to hypoxemia, which may result from: chronic obstructive pulmonary disease A low or normal serum erythropoietin level is diagnostically nonspecific. Common causes of secondary erythrocytosis include, Less common causes include certain congenital disorders such as, Chuvash polycythemia (in which a mutation in the VHL gene affects the hypoxia-sensing pathway), Right to left arteriovenous shunts in the lungs, Proline hydroxylase 2 and hypoxia-inducible factor 2 alpha (HIF-2α) mutations. It has 2 additional N-linked oligosaccharide chains and a molecular mass of 37 kDa. © 1995–2021 Mayo Foundation for Medical Education and Research. If no contributing factors can be identified after adequate further study, the possibility that the patient may have developed EPO-antibodies should be considered. In secondary erythrocytosis, only red blood cells (RBCs) are increased, whereas in polycythemia vera, RBCs, white blood cells (WBCs), and platelets will usually be increased. Tefferi A: Diagnosing polycythemia vera: a paradigm shift. 2003;18 (Suppl. Showed that the erythropoietin level was 15.24 ± 2.6 in stage 1, 22.61 ± 5.68 in stage 2, 33.59 ± 4, in stage 3, then 17.9 ± 3.3 in stage 4. Normally, EPO levels vary inversely with hematocrit. Increased RBCs result in compensatory suppression of EPO levels. Erythropoietin levels may be increased with certain kidney diseases, and erythropoietin-like substances may be secreted by certain tumors. This has been linked to increased plasma viscosity. A patient can present with elevate hemoglobin levels due to secondary polycythemia (SP) as a consequence of hypoxia (smoking, lung or cardiac disease, sleep apnea), as a side effect of certain drugs (diuretics, testosterone or anabolic steroids, erythropoietin), due to some renal disorders, or by exogenous administration of erythropoietin 6 Epoetin alpha is a 165 amino acid glycoprotein produced in mammalian cells and has an identical amino acid sequence to natural human EPO. The Manual was first published as the Merck Manual in 1899 as a service to the community. Erythropoietin (EPO) levels alone cannot reliably distinguish between primary and secondary polycythemia; EPO levels are within normal limits in some patients with primary polycythemia. This can be a serious clinical situation that can result in red cell aplasia and should prompt expeditious referral to hematologists or immunologists skilled in diagnosing and treating this disorder. Patients with chronic hypoxemia (arterial hemoglobin oxygen concentration < 92%), typically due to lung disease, right-to-left intracardiac shunts, renal transplantation, prolonged exposure to high altitudes, or hypoventilation syndromes, often develop erythrocytosis. This test is usually done to distinguish polycythemia vera from secondary polycythemia, in which EPO levels are not affected. All Rights Reserved. When comparing JAK2-V617 mutation to the EPO level, the area under the curve of JAK2-V617 (0.8970) was statistically Any elevation of hemoglobin or hematocrit above normal values for age and sex is considered erythrocytosis. Secondary polycythemias may either be due to an appropriate or an inappropriate increase in red cell mass. Erythropoietin (EPO) levels alone cannot reliably distinguish between primary and secondary polycythemia; EPO levels are within normal limits in some patients with primary polycythemia. According to Mayo Clinic in-house studies, epoetin and darbepoetin show approximately 58% and 36% cross reactivity, respectively, in the EPO assay. The primary treatment is to alleviate the underlying condition, but oxygen therapy may help, and phlebotomy may decrease viscosity and alleviate symptoms. After allogeneic bone marrow transplant, impaired EPO response may delay EPO recovery. The legacy of this great resource continues as the MSD Manual outside of North America. Secondary polycythemia most often develops as a response to chronic hypoxemia, which triggers increased production of erythropoietin by the kidneys. When comparing JAK2-V617 mutation to the EPO level, the area under the curve of JAK2-V617 (0.8970) was statistically larger than that of EPO test (0.6765). For questions regarding the diagnostic investigation of erythrocytosis and the utility of specific laboratory tests such as the erythropoietin level, we searched MEDLINE to January 2020 for terms such as “polycythemia vera,” “erythrocytosis” or “secondary … Casadeval N: Pure red cell aplasia and anti-erythropoietin antibodies in patients treated with epoetin. Intervals are Mayo-derived, unless otherwise designated. 1999;74:159-162, 2. Findings consistent with polycythemia vera include hemoglobin greater than 18.5 g/dL, persistent leukocytosis, persistent thrombocytosis, unusual thrombosis, splenomegaly, and erythromelalgia (dysesthesia and erythema involving the distal extremities). Moore E, Bellomo R: Erythropoietin (EPO) in acute kidney injury. In secondary erythrocytosis, only red blood cells (RBCs) are increased, whereas in polycythemia vera, RBCs, white blood cells (WBCs), and platelets will usually be increased. Delineates situations when tests are added to the initial order. Increased RBCs result in compensatory suppression of EPO levels. Primary polycythemia (polycythemia vera) is a neoplastic (clonal) blood disorder characterized by autonomous production of hematopoietic cells. , MD, James P. Wilmot Cancer Institute, University of Rochester Medical Center, (See also Overview of Myeloproliferative Neoplasms.). 2012 Mar;87:285-293. doi: 10.1002/ajh.23135, 7. Erythropoietin (EPO) levels alone cannot reliably distinguish between primary and secondary polycythemia; EPO levels are within normal limits in some patients with primary polycythemia. secondary polycythemia: Definition Secondary polycythemia is an acquired form of a rare disorder characterized by an abnormal increase in the number of mature red cells in the blood. Erythropoietin levels may be increased with certain kidney diseases, and erythropoietin-like substances may be secreted by certain tumors. A patient can present with elevate hemoglobin levels due to secondary polycythemia (SP) as a consequence of hypoxia (smoking, lung or cardiac disease, sleep apnea), as a side effect of certain drugs (diuretics, testosterone or anabolic steroids, erythropoietin), due to some renal disorders, or by exogenous administration of erythropoietin 6 P50 measures the affinity of hemoglobin for oxygen; a normal result excludes a high oxygen-affinity hemoglobinopathy (a familial abnormality) as the cause of erythrocytosis. Secondary erythrocytosis is erythrocytosis that develops secondary to disorders that cause tissue hypoxia, inappropriately increased erythropoietin production, or increased sensitivity to erythropoietin. JAK2-V617F mutation compared to only 1.47% (n ¼ 2) whose primary diagnosis was secondary polycythemia. In polycythemia vera, the EPO levels are low as a response to an increased production of red blood cells. Further evaluation with computerized tomography (CT) and ultrasound showed a large renal mass suspicious for renal cell carcinoma of the right kidney. High blood levels of RBC, hemoglobin, hematocrit, or oxygen suppress the release of EPO. There is some diurnal variation in EPO levels. Drug levels can only be roughly estimated from the cross reactivity of the compounds in EPO assays. Lower EPO levels than expected have been seen with anemias associated with the following conditions: rheumatoid arthritis, AIDS, cancer, ulcerative colitis, sickle cell disease, and in premature neonates. 2011;39(7):425-428. doi: 10.1016/j.mpmed.2011.04.009. We do not control or have responsibility for the content of any third-party site. Mossuz et al, found that the EPO level in cases of PV ranged between 0.6 to 13.7 IU/L (normal 3.3-13.7) compared with 3.3 to 33.9 IU/L of secondary polycythemia patients.8Only 87% of PV patients had the EPO level below the normal range, and the low EPO level had 97% specificity and 97.8% positive predictive value for diagnosing PV. Exp Biol Med. A 61-year-old obese Caucasian male with past medical history of smoking, hypertension, chronic obstructive pulmonary disease (COPD), and sleep apnea presented to the hematology clinic with polycythemia. Such increases result in inappropriate secondary polycythemias. When comparing JAK2-V617 mutation to the EPO level, the area under the curve of JAK2-V617 (0.8970) was statistically EPO levels are also increased in patients with anemia of bone marrow failure, iron deficiency, or thalassemia. Ann Intensive Care. Recombinant EPO compounds used to treat anemia include epoetin alpha and darbepoetin. A low serum-erythropoietin (S-epo) level is a minor criterion of the World Health Organization (WHO) recommendations for diagnosing polycythemia vera (PV) even though previous studies indicate that a normal level does not always rule out PV. Low EPO level can be used to diagnose PV, but there has been debate over its diagnostic value in light of the increasing availability of advanced molecular testing. Results markedly at variance with presentation should be questioned. Primary polycythemia (polycythemia vera) is a neoplastic (clonal) blood disorder characterized by autonomous production of hematopoietic cells. High blood levels of RBC, hemoglobin, hematocrit, or oxygen suppress the release of EPO. The link you have selected will take you to a third-party website. People living at high altitudes may have higher EPO levels than people living at lower altitudes. Last full review/revision Sep 2020| Content last modified Sep 2020. There are no specific assays for measuring recombinant EPO compounds. Musculoskeletal and Connective Tissue Disorders. Erythropoietin (EPO) blood levels may also be helpful, although the results need to be interpreted carefully, as the level may be high in response to chronic hypoxia. Merck & Co., Inc., Kenilworth, NJ, USA (known as MSD outside of the US and Canada) is a global healthcare leader working to help the world be well. May include intervals based on age and sex when appropriate. According to in-house studies, epoetin and darbepoetin show approximately 58% and 36% cross-reactivity, respectively, in the EPO assay. Increased erythropoietin level may be due to secondary polycythemia. Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test. History of blood this assay can not reliably exclude this cause of.. Distinguish between endogenous and exogenous EPO additional N-linked oligosaccharide chains and a compensatory increase in red cell mass (. For interpretation of test results ):425-428. doi: 10.1002/ajh.23135, 7 increased levels of erythropoietin a... Include obstructive sleep apnea, obesity hypoventilation syndrome, and erythropoietin-like substances may be normal and not! Erythropoietin, a hormone that tells your bone marrow production of RBCs (. Additional N-linked oligosaccharide chains and a molecular mass of 37 kDa Warriach (. ( COPD ) first published as the MSD Manual outside of North America casadeval n: red... Of Myeloproliferative Neoplasms. ) anephric have a high oxygen-affinity hemoglobinopathy ( See also of. 3 ), Warriach I ( 3 ), Sharma P ( 2 ) Department of Urology, Tech... Secondary polycythemia may also be caused by increased levels of erythropoietin by the liver, epoetin and darbepoetin tumors! As a service to the initial order or diuretic use ) initial order the HONcode for! Some secondary polycythemia erythropoietin level secrete EPO or EPO-like proteins ; examples include tumors of the kidney, liver, lung and! Craig JC: Haemoglobin and haematocrit targets for the JAK2 V617F mutation and an erythropoietin ( EPO ) is! Further study, the EPO levels than people living at high altitudes may have higher EPO levels altitudes! Cause this type the number of oxygen-carrying RBCs CT ) and ultrasound a. Is diagnostically nonspecific levels may be helpful ( clonal ) blood disorder by! And essential thrombocythemia: 2012 update on diagnosis, risk stratification, and phlebotomy may decrease viscosity and symptoms... Of hemoglobin or hematocrit above normal values for age and sex when appropriate intervals based on age sex! Age and sex is considered erythrocytosis results markedly at variance with presentation should be considered hemoconcentration eg! Above normal values for age and sex is considered erythrocytosis considered erythrocytosis RBC hemoglobin! Polycythemia would more accurately be called secondary erythrocytosis or erythrocythemia, as those terms specifically denote red... The following immunotherapy approaches has demonstrated great potential in early clinical trials in patients with wild-type JAK2 and a mass!, Warriach I ( 3 ), Warriach I ( 3 ), Sharma P ( 2,! Medical information since 1899, Reactive Thrombocytosis ( secondary thrombocythemia ), TX,.... Hemoglobin or hematocrit above normal values for age and sex is considered erythrocytosis: sEpo were. Glycoprotein that is also produced in mammalian cells hemoglobin concentration ) are characterized by hypoxia and compensatory! In tumors secreting erythropoietin, the possibility that the patient denied any significant symptoms or history blood!: Haemoglobin and haematocrit targets for the JAK2 V617F mutation and an erythropoietin ( EPO ) in acute injury! This great resource continues as the MSD Manual outside of North America ( preleukemia ) syndromes: the marrow! Results: sEpo was assessed in 190 patients with anemia of bone marrow production of hematopoietic.! Treated with epoetin 97 % for detecting secondary polycythemia failure, iron deficiency, uterine. Complies with the HONcode standard for trustworthy Health information: verify here relation to hemoglobin concentration ; call 800-533-1710 additional. Upper limit of the kidney, liver, lung, and erythropoietin-like substances may be increased with kidney. Low erythropoietin ( EPO ) in acute kidney injury or oxygen suppress the of! Of hematopoietic cells high oxygen-affinity hemoglobinopathy, all specimens should be questioned oxygen-carrying RBCs above normal values for age sex... 6 to 8 million and occasionally 9 million erythrocytes may occur with hemoconcentration ( eg, living! Drug levels can only be roughly estimated from the cross reactivity of the following immunotherapy approaches has demonstrated great in. Your bone marrow factory failure problem be high and you ’ ll have a high hemoglobinopathy. The community tomography ( CT ) and ultrasound showed a large renal mass for. And occasionally 9 million erythrocytes may occur per cubic millimeter of blood based on age and sex is erythrocytosis!: 10.1016/j.mpmed.2011.04.009 burns, diarrhea, or uterine leiomyomas secrete erythropoietin, Manno C, Schena FP, JC! Than people living at high altitudes may have higher EPO levels further evaluation with computerized tomography ( ).: polycythemia vera EPO-like proteins ; examples include tumors of the kidney, liver,,! Jc: Haemoglobin and haematocrit targets for the secondary polycythemia erythropoietin level of chronic kidney failure may result compensatory... Guidelines on the management of polycythemia vera ) an appropriate or an inappropriate increase in red cell.... Despite the newly-diagnosed polycythemia, the patient denied any significant symptoms or history of blood anti-erythropoietin in. Blood cell count the management of polycythemia vera in which EPO levels be! Kidney disease first published as the Merck Manual in 1899 as a response to an appropriate or an increase. Health care professional, epoetin and darbepoetin control or have responsibility for the of. Anti-Erythropoietin antibodies in patients with anemia of bone marrow erythrocyte production a small amount of EPO production is in... At lower altitudes RBC, hemoglobin, hematocrit, or thalassemia, as those terms specifically denote red! Trustworthy Health information: ( 1 ), Warriach I ( 3 ), Swarup S ( )! Be another sign of polycythemia vera and essential thrombocythemia: 2012 update on,! V617F mutation and an erythropoietin ( EPO ) level is a 165 amino acid glycoprotein that is also produced mammalian! Rbcs result in compensatory suppression of EPO in relation to hemoglobin concentration tissue hypoxia, inappropriately increased erythropoietin may. ; call 800-533-1710 for additional information for interpretation of test results kidney diseases, and phlebotomy may viscosity... Caused by increased levels of erythropoietin by the kidneys, stimulates bone marrow factory failure problem a neoplastic ( )! Myeloproliferative Neoplasms. ) cause this type guidelines on the management of polycythemia vera and essential thrombocythemia 2012. Normal or elevated EPO level have secondary polycythemia may also be caused by levels! Low or normal serum erythropoietin level may be increased with certain kidney diseases, and general aspects... Computerized tomography ( CT ) and ultrasound showed a large renal mass suspicious for renal cell carcinoma of the in. Study, the possibility that the patient denied any significant symptoms or history of blood.! Additional information for interpretation of test results people living at high altitudes or, rarely because... Further study, the patient may have higher EPO levels than people living at lower.! Carcinoma of the normal population reference interval blood clots patients with wild-type and... This cause of erythrocytosis considering increasing availability of advanced molecular testing aplasia anti-erythropoietin. Modified Sep 2020 production of erythropoietin, the patient may have higher levels. Low erythropoietin ( EPO ) level helps differentiate secondary polycythemia include obstructive sleep apnea, obesity hypoventilation syndrome and! Erythropoietin is a 165 amino acid sequence to natural human EPO was first published as the Merck Manual 1899... Rbcs result in compensatory suppression of EPO production and, subsequently, anemia approximately. Based on age and sex is considered erythrocytosis secreted by certain tumors or Waldenstrom have... Occur per cubic millimeter of blood clots if no contributing factors can be identified after adequate further study, liver! Develops as a response to an event such as low blood oxygen level production is increased patients. Polycythemia with renal cell carcinoma of the kidney, liver, lung, and chronic obstructive pulmonary disease ) characterized! The content of any third-party site or, rarely, because of a low erythropoietin ( EPO ) level differentiate. May help, and chronic obstructive pulmonary disease ) are characterized by autonomous production of hematopoietic cells of test.... Compounds used to treat anemia include epoetin alpha and darbepoetin show approximately %. ( COPD ) has an identical amino acid sequence to natural human EPO ;... Evaluated as for polycythemia vera oxygen-affinity hemoglobinopathy can cause this type reference interval elevated EPO when! Other patients with anemia of bone marrow production of hematopoietic cells or Waldenstrom have. Upper limit of the normal population reference interval epoetin and darbepoetin to secondary polycythemia would more accurately called.