Patient 1: Polycythemia with microcytosisis is seen: 1) in patients with polycythemia, either primary or secondary, who have become iron deficient. 2) in patients with thalassemia minor or some other hemoglobinopathies (e.g.: hemoglobin E) who’ve developed polycythemia, either primary or secondary.

Patients with polycythemia have higher risk of getting iron deficiency, firstly because they use their iron stores to make extra hemoglobin; and if they don’t take in a diet with high iron content, they become iron deficient. Secondly, because patients with polycythemia have a higher risk of getting a peptic ulcer. Patients with polycythemia and iron deficiency should have a complete GI investigation, to make sure that they don’t have a GI lesion that needs special treatment. But their iron deficiency shouldn’t be corrected unless they have symptoms referable to iron deficiency.

Patient 2: Polycythemia with macrocytosis in a patient with normal serum B₁₂ is seen when polycythemia is associated with conditions that cause macrocytosis. Some of these conditions are: ethanol abuse, obstructive jaundice, liver disease, absence of spleen, erythropoietin injection (athletes using erythropoietin for performance enhancement, develop polycythemia as well as macrocytosis) and chemotherapy.

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