Secondary Polycythemia

– Increased WBC will indicate infection, or secondary to trauma (stress reaction); in rare cases may signal hematologic disturbance (i.e., leukemia)

11. What predisposing factor, identified in S.P.’s medical history places her at risk for infection, bleeding, and anemia?

Hypoxia stimulates the kidneys to increase the release of the hormone erythropoietin. Erythropoietin is produced by the kidneys to increase the number of RBC precursors. Erythropoiesis is the process of red blood cell formation.

Aplastic anemia is a condition where bone marrow does not produce sufficient new cells to replenish blood cells.[1] The condition, per its name, involves both aplasia and anemia. Typically, anemia refers to low red blood cell counts, but aplastic anemia patients have lower counts of all three blood cell types: red blood cells, white blood cells, and platelets, termed pancytopenia.

3. When a diagnostic statement of anemia is not qualified in any way, what should the coder do?

The WBC and platelets are high because the Pt.’s body is trying to fight an infection.

As a provider, one will care for many patients that have different types of anemia. Anemia is not so much as a disease as a symptom of an underlying issue. Although there can be particular signs and symptoms associated with anemia, the basis of a diagnosis is from laboratory data. For the purpose of this discussion, I will evaluate a case study and give a differential diagnosis. I will also assess how patient history, physical exam, and lab reports support my diagnosis. I will explain the pathophysiology of the type of anemia and give causes and treatment options available.

If the patient happens to have any of the symptoms of leukemia, any type, it is recommended to consult a doctor immediately to have a blood test taken.

His hematocrit is 52% which is elevated from the normal 45% in men. The polycythemia occurs due to the presence of hypoxemia due to his COPD. The body will produce more red blood cells to attempt to increase the amount of O2 being delivered to the body tissue.

People who have Myelodysplastic Syndrome may not experience symptoms at the beginning of the disease. However, there are three main signs that can develop and alert healthcare providers that something is wrong. One of these is a low red blood cell count, or Anemia. Most patients that have myelodysplastic syndromes exhibit this indicator when first diagnosed. A normal red blood count can vary between 4.0 and 6.1 million red blood cells per microliter of blood in the body, depending on the age and sex of the patient. A red blood cell count lower than normal is characteristic of Anemia (Cafasso, Jacquelyn, and Gotter). Not only is Anemia shown by constantly low hematocrit, but it can also be characterized by constantly low hemoglobin. A normal hemoglobin count is between 12.0 and 15.5 grams per deciliter of blood for females, and 13.5 to 17.5 grams per deciliter of blood for males. Levels lower than these show a low hemoglobin level (Mayo Clinic, Hemoglobin Test). Hemoglobin is the protein in blood that carries oxygen to the different tissues in the body.

Also known as normocytic anemia. This is the most frequent type of anemia most often happening to males over 85 years old. It is a common problem that occurs to men and women over 85 years old. Symptoms include and are caused by: a reduced production of normal-sized red blood cells even though presence of hemoglobin in the red blood cells is within the standard range; an increased production of HbS as is seen in sickle cell diseases; greater destruction and loss of red blood cells; an increase in plasma volume that is not compensated by anything else; a B2 (riboflavin) deficiency; and a B6 (pyridoxine) deficiency. (Brill & Baumgardner 2000).

Review Sheet Results 1. List the hematocrits for the healthy male (sample 1) and female (sample 2) living in Boston (at sea level) and indicate whether they are normal or whether they indicate anemia or polycythemia. Your answer: Healthy Male (Sample 1) = 48 and Healthy Female = 44. Both are normal as the average hematocrit for males is 42-52%, and the average for females is 37-47% 2. Describe the difference between the hematocrits for the male and female living in Boston. Why does this difference between the sexes exist? Your answer: The difference is that men have a higher hematocrit due to being larger in size than women and having more muscle mass and it has been shown that testosterone affects the secretion of erythropoietin (EPO) by the kidneys. EPO is responsible for the formation of red blood cells. Higher testosterone in males means more red blood cell formation and hence a higher hematocrit. 3. List the hematocrits for the healthy male and female living in Denver (approximately one mile above sea level) and indicate whether they are normal or whether they indicate anemia or polycythemia. Your answer: Male=55, Female=53 ; Both are elevated

R.S.’ causes of having polycythemia is a result of inadequate oxygen due to his smoking. Because there's less oxygen in the blood, the body tries to overcome the deficiency by making more red blood cells. Unfortunately, the body just keeps on producing until it is too many. Due to R.S.’ heavy smoking and coronary artery disease a proliferation in carbon monoxide in the blood that can lead to higher red blood cell and hemoglobin levels to

In LP’s case, what brought her to the clinic was an uncontrollable itch that she believed was an allergy for which her primary care provider (PCP) requested to have a complete blood count (CBC) done which measures various components of a person’s blood such their white blood cells, red blood cells, hemoglobin, hematocrit, and platelets (Mayoclinic, 2017). The results showed an increase in all components. If the PCP is suspicious of PV, they can refer the patient for a follow-up blood test to check for the JAK2 gene mutation (AACC, 2017). The patient can also be referred to a hematologist to have a bone marrow aspiration or biopsy done in which a special wide needle is used to remove a sample of hip bone along with the bone marrow and then sent to the laboratory for further testing (NCI, n.d). Results are sent back to the PCP, and if the patient meets the diagnostic criteria for PV, the results from the biopsy can be used to determine the baseline of how the disease is going and give ability to further monitor progression. Bone marrow biopsy is also used for genetic testing of the JAK2 mutation (Mayoclinic, 2017). When the body is forming and breaking down clots, proteins called D-dimers are released which can be detected with a blood test. The healthcare provider can order this specific test if the patient is experiencing symptoms of DVT or PE. If the patient is presented with a high probability of PE based on clinical assessment or a positive D-dimer test, a spiral computed tomography (spiral CT) can be ordered. Spiral CT uses a combination of x-rays and computer with intravenous dye to take detailed pictures of the patient’s blood vessels and any abnormalities such as blood clots (Thompson & Kabrhel,

• A bone marrow sample helps find signs of cancer that could be affecting blood production.