21 Feb 2015

Clinical Features of polycythaemia

Polycythemia is a condition in which there is elevation of hemoglobin in the blood more than the normal. When hemoglobin level raise that increases the blood viscocity and lead to variety of manifestation. As it take time to increase the hemoglobin level the symptoms are also insidious. Level of hemoglobin at which each patient develop symptom vary, depending on bodies ability to adapt to the situation. Initially symptoms are mild but as the Hb is more than 20 g/d Llife threatening complication can occur.
General appearance

Increased hemoglobin and blood level causes noticeable A diffuse dusky redness of face which is called facial plethora, with bloodshot eyes  and diffuse purplish redness of oral mucosa and,palms

Conjuctival injection can occur.

Severe itching after hot bath or when the patient is warm is a feature of polycythemia which is called aquagenic pruritus.
Gout due to increased uric acid level is common.
Some patients experience stomach ulceration and heartburn.Severe malaise and fatigue are also reported.
Neurologic symptoms
Due to increased blood viscosity patients experience vertigo, tinnitus, headache, visual disturbances,mental clouding and TIA  (transient ischemic attack)
Hypertension is also common in these patients.
Arterial and venous occlusion
Life threatening complication can occur when the hemoglobin is more than   20 g/dL.At this level hyperviscocity is markedly increased and blood flow to vital organ decreases.The most common organs affected are brain ,heart, abdomen liver .Manifestation include stroke ,heart attack,hepatic vein occlusion,ischemia to the digits.
Bleeding manifestation.
Patients can develop life threatening hemorrhage. This is due to hyperviscosity leading to rupure of vessels. Unteated polycythemia patients are at risk of increased bleeding during surgery or trauma.Other bleeding manifestation include  easy bruising,epistaxis ,gastrointestinal hemorrhage.On examination spleenomegaly is common in Primary polycythemia patients.

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