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Asked for Male | 67 Years

Am I Dealing with Polycythemia Vera or Secondary Cause?

Patient's Query

Dear Doctor, Due to my father's high blood viscosity, suspicion of polycythemia arises, necessitating blood draws every 3 weeks to maintain appropriate levels. At 69 years old, he experiences symptoms such as skin itching, swelling, head numbness, and fatigue. Currently, his JAK2 V617F mutation showed 0.8 then 1.2%, with JAK2 exon 12 negative and EPO at 13.4. Abdominal CT and chest X-ray are normal. After a few months of phlebotomy, his levels normalized. Now, we await the bone marrow biopsy results, which do not confirm Polycythemia Vera: "Microscopic description: The bone marrow biopsy sample shows somewhat hypocellular hematopoietic parenchyma relative to age, which is terminally mature. Myeloid ratio is 2:1 with dominance of late precursors; no blast cells are noted. The number of megakaryocytes is normal with no clustering. There is no interstitial fibrosis or lymphoid infiltrate. Diagnosis: Mature, hypocellular hematopoietic parenchyma without myeloproliferative features. Cytogenetic analysis confirmed male karyotype; no clonal chromosomal abnormalities detected. Indication for examination D7510 Secondary polycythemia Note Submicroscopic rearrangements, small structural chromosomal aberrations, DNA-level differences cannot be ruled out with the method used." I am quite confused as JAK2 positivity typically suggests PV, yet the biopsy suggests otherwise, possibly indicating secondary polycythemia. Could you please clarify based on this information what you personally think is more likely, Polycythemia Vera or another secondary cause? Thank you very much for your help.

Answered by Dr. Babita Goel

Your father's symptoms and test results do suggest some complexity. The presence of JAK2 mutation often points towards Polycythemia Vera (PV), but the bone marrow biopsy does not show typical myeloproliferative features, suggesting it might be secondary polycythemia instead. Consult a hematologist, specializing in blood disorders, and can provide a more accurate diagnosis and appropriate treatment plan.

 

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Questions & Answers on "Hematology" (101)

Is 3.5 mmol/l cholesterol is normal

Male | 37

When you have 3.5 mmol/l cholesterol, that is okay. Cholesterol is like fat in your blood. If your cholesterol is high, there are usually no signs. An unhealthy diet, not doing enough exercise, and a family history can cause this condition. To stay healthy with it being normal eat well and exercise regularly also if necessary take some drugs from the doctor. 

Answered on 6th June '24

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My uric acid test report 5.9 please tell me ok not ok

Male | 29

The uric acid level of 5.9 is already above normal. It might remain asymptomatic at first, yet if untreated, it may lead to gout, which is characterized by pain and swelling in the joints. Your uric acid level can be decreased by drinking more water, avoiding alcohol, and less red meat and seafood. Besides this method, exercising regularly may also be beneficial.

Answered on 20th Aug '24

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Vit b12 very low less than 100 Hscrp very high 20.99( taken at the time of menstruation) Hb slightly low 11.6 Bun creatinine slightly low Iron was very low 34.46 AVG bld glucose slightly low 88

Female | 19

It looks like there are certain elements that are below the required levels in your body. For it to function properly, your body needs them. Feeling tired, weak, or unlike yourself can be signs of insufficient amounts of these substances. When some substances are too many, then it may mean that the body is fighting something. To help you feel better soon, you might have to take such supplements like Vitamin B12 or Iron among others. 

Answered on 27th May '24

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Typhoid IgM antibody Weak positive means..??

Female | 21

Typhoid IgM antibody denote­s your system battles a nasty bug, typhoid feve­r. High temprature, fatigue, tummy hurt, head pain. Te­st helps spot early. Hydrate we­ll. Take antibiotics. Rest up. Follow doctor's orders. 

Answered on 25th July '24

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My wife is suffering with low hemoglobin, RBC , WBC & patlets count gone on decreasing .She has sufferd with viral fever for 15 days, viral fever came to normal but counts were not increasing.she has treated 20 days in KIMS, hyderabad hospital. Kims doctors told that after few days gradually counts will increase. What is her problem upto now doctors did not diagnosis, Two or three days doctors are transmitting sdp and prbc and WBC injections.I'm taken second opinion he told that there is a problem in bone marrow.without daignoses if we take bone marrow treatment does patient get any side effects.she is suffering from legs pain and swalling in legs aslo and she is becoming weak. Please what is her problem give me the clarity

Female | 36

she needs detailed hematological evaluation.and depending on all the reports, diagnosis can be made 

Answered on 23rd May '24

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We have done test of asylum serum and it is increased in reports at 142. Is it something to worry about

Male | 44

You had a high result for asylum se­rum, at 142. This could signal an issue with your liver or bones. Fe­eling tired, losing weight, or be­lly pain, are possible symptoms. Causes: live­r problems, or bone troubles. It's wise­ to see a doctor to find out what's happening. The­y can determine the­ right treatment. 

Answered on 23rd July '24

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I have 16 pea sized lymph nodes I am 57kg my height is 5ft 10 I’ve had them for almost 2 years and they haven’t got bigger or changed I’ve had blood tests previously and they all came back fine. I do have 2 under my jaw that’s a bit bigger than a pea though. Is it a concern? I have no symptoms except bad anxiety. I am highly afraid of cancers

Male | 17

Your lymph nodes not changing size or growing for two years is good. When it comes to cancer we tend to worry a lot due to anxiety. They might remain slightly enlarged sometimes. It’s usually benign but it would be prudent to get the larger ones checked by your doctor. Additionally, work on calming down your nerves because that can also be of help.

Answered on 30th May '24

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Fews days Back I got viral fever I was cure later according to blood test reports i find blood infection then I got joint pains on legs when stoped antibiotics gain join pains was getting

Female | 20

You might have been affected by an infection with a virus that has in turn caused a blood infection which in turn may cause joint pains in your legs. Antibiotics can disrupt the equilibrium of our body's good bacteria, causing joint pain. For relief of the joint pains, you can try gently exercising, using heat or ice treatment, and taking a break. Stay well-hydrated and eat fresh and good foods to provide adequate support to your body during the healing process.

Answered on 21st June '24

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10:48 Investigation Observed Values HAEMATOLOGY Units Blological Ref. Interval Complete Blood Count Haemoglobin 12.2 Total Leucocyte Count (TLC) 14700 gm/dL cells/mm² 12-16.5 Differential % Leucocyte Counts: Granulocytes 71.6 % 40-75 Lymphocytes 23.1 % 20-45 Mid Cell 5.3 % 1-6 Platelet Count 2.07 Lac cells/mm² 150000-400000 LPCR 22.2 % 13.0-43.0 MPV 9.1 fl. 1.47-7.4 PDW 12.1 % 10.0-17.0 PCT 0.19 & 0.15-0.62 Total RBCs MCV (Mean Cell Volume) 4.17 Million cells/uL 4-4.5 72.7 fl. 80-100 MCH (Mean Corpus. Haemoglobin) 29.4 pg 27-32 MCHC (Mean Corpus. Hb Conc.) 40.4 g/dl 32-35 HCT (hematocrit) 30.3 RDWA RDWR 40.4 11 % fL 36-46 37.0-54.0 % 11.5-14.5

Female | 48

According to the blood test results you provided, the total white blood cell (TLC) count is above the norm, which may be indicative of an infection or inflammation in the body. High TLC may come with symptoms like fever, fatigue, and coolness of the body. To deal with this problem, it is necessary to find the primary cause of the increased TLC level by conducting more tests and getting a doctor's opinion for suitable treatment.

Answered on 8th Aug '24

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I'm 21 years old women I've a question today i had a CBC 1 blood test and 3 days back i smoked cigarette will my doctor be able to make out by seeing my blood reports that i smoked ?

Female | 21

Cigarette smoking tends to impact the results of CBC blood tests but they don’t directly reveal it. By increasing your white blood cell count, smoking may indicate signs of inflammation or an infection to a physician. Tell truthfully about your smoking habits when asked by healthcare practitioners so that they can provide appropriate treatment for you.

Answered on 11th June '24

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RBC level 5.10 wht to do dr please answer

Female | 32

Red blood ce­lls are important. Too many is not good. A level of 5.10 is a bit high. That can happe­n for different reasons. Maybe­ you didn't drink enough water. Or maybe you smoke­. Some medical issues like­ polycythemia can also cause it. You might fee­l tired, dizzy, or get headache­s. To fix it, drink lots of water. Don't smoke. Follow your doctor's advice. 

Answered on 19th July '24

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Stem cell transplant for sickling

Female | 13

When red blood cells change shape and get stuck in the body, sickling occurs, which causes pain and infections. It is due to an error in your genetic makeup that you were born with. By providing new cells that create healthy blood, a stem cell transplant may correct this. Eventually, such a therapy could lower the frequency of sickling and improve overall well-being.

Answered on 30th May '24

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I am having swollen lymph nodes in my neck since two years I have done fnac and biopsy both comes with result reactive lyphadenopathy....is it Cancer????

Female | 23

Reactive lymphadenopathy means the lymph nodes are responding to something which is not necessarily cancer. This can be caused by infections such as colds. Skin conditions can also cause them. Your doctor might want to keep an eye on them for a while or do more tests to be sure. Changes are always best recorded and communicated with a healthcare provider. 

Answered on 25th June '24

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Systematic increases in immature granulocytes Good morning, Firstly, I will mention that I suffer from numerous chronic inflammatory diseases, as this may be relevant. These include Ulcerative Proctitis; Atrophic Gastritis; Last year, I also underwent two cervical electrosurgery procedures due to advanced dysplasia (CIN3). (The last colposcopy and colonoscopy did not reveal any suspicious changes) For a year now, my blood morphology tests have been showing an elevated level of immature granulocytes: The latest test (May '24) showed: Immature granulocytes IG - 0.09 thousand/µl; Norm: 0-0.04 thousand/µl Immature granulocytes IG % - 1.00; Norm: 0-0.5% The rest of the blood morphology is normal, leukocytes in urine - within the norm. Previous results (April '23): Immature granulocytes IG - 0.05 thousand/µl; Norm: 0-0.04 thousand/µl Immature granulocytes IG % - 0.7; Norm: 0-0.5% (and a very slightly elevated MCV) Even older (January '23): Immature granulocytes IG - 0.04 thousand/µl; Norm: 0-0.04 thousand/µl Immature granulocytes IG % - 0.6; Norm: 0-0.5% (and a very slightly elevated MCV and basophils) There is a clear upward trend since last year. I initially thought this was due to extreme stress (CIN3, LLETZ etc). Now I am not so sure... Are these results very concerning and indicative of a cancerous process? Can chronic inflammatory states cause an increase in IG, or is it rather some kind of “acute” disease state? Could the fact that I rode a bike to the laboratory (medium and short-term physical effort) affect the increase in results? I would be very grateful for your response and advice. Best regards, J.

Female | 40

Raised levels of these are often linked to chronic inflammation similar to stress, in this case, it is important to control them initially. With the status of attempted diagnosis for specific inflammatory conditions, your previous experience, and the new procedures on the lookout for anything new, don't hesitate to let a doctor know. It would be helpful to get solid advice from your healthcare provider concerning your test results. 

Answered on 23rd May '24

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I have tested my iron deficiency today and it was low so can i take "Astyfer-Z hematinic with amino acids vitamins and zinc liquid syrup" Which my father bought from a medical store and asked to take 10ml per day , is it okey to take it

Male | 21

Iron deficiency can cause you to have low energy, feel weak, and may lead to malfunctioning of the human body. This is due to the insufficient intake of iron-rich foods and blood loss. Aspyfer-Z syrup boosts iron levels in your body and contains iron, amino acids, B-group vitamins, and zinc. It can be done under the supervision of your father but ensure you get a follow-up guide from a doctor.

Answered on 20th Aug '24

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Is it possible that a person have Alpha thalassemia major and still not taking any blood transfusion in entire life and now 21 yo.....or the person have only minor one

Female | 21

Alpha thalassemia major can be present in a patient who does not require blood transfusions. This form of the disorder can result in severe anemia, although it affects people differently. Some individuals may not need a transfusion at all. Signs and symptoms of alpha thalassemia may include fatigue, weakness, or paleness of skin. Treatment may consist of symptom management such as taking supplements or drugs that stimulate the production of more red blood cells within the body. Please consult a doctor for individualized advice.

Answered on 25th June '24

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