Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 165: A 63-Year-Old with an Elevated Hemoglobin
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Sep 25, 2025 Dive into the intriguing case of a 63-year-old with elevated hemoglobin tied to fever and diarrhea. Discover how travel history and heavy tobacco use play into the diagnosis. Learn about the difference between primary and secondary polycythemia, including the pivotal role of EPO levels and the implications of JAK2 mutations. The importance of identifying hyperviscosity symptoms and when to administer phlebotomy is discussed, wrapping up with key takeaways on effective management strategies.
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Case Presentation And Risk Factors
- A 63-year-old man traveling in the Caribbean had fever and diarrhea and was found to have a hemoglobin of 17 g/dL on routine labs. He lives in Delaware, is a lifelong smoker, and uses CPAP variably for obstructive sleep apnea.
When To Suspect Polycythemia
- Polycythemia is triggered when hemoglobin exceeds ~17 g/dL in men and hematocrit thresholds help identify abnormal red cell mass. Hematocrits over 60% in men almost always indicate increased red cell mass and higher viscosity risk.
Hyperviscosity And Clinical Risks
- Increased red cell mass causes hyperviscosity leading to neurologic symptoms and thrombosis risk. Blood viscosity rises sharply with hematocrits above ~55%, increasing thrombotic complications.
