1. Practical Clin Path Polycythemia
Wendy Blount, DVM

2. Polycythemia Polys – many Cytos – cell Haima - blood
Aka – erythrocytosis
RBC >10 x 106/ul in the dog
RBC >8.5 x 106/ul in the cat
PCV >55-60% in the dog
PCV >45-50% in the cat
Relative polycythemia – decrease in plasma volume (hypovolemia), resulting in falsely increased PCV/HCT
plasma protein often elevated
Fluid loss
Lack of access to or intake of water
Splenic contraction (temporary, due to stress – dogs only)

3. Absolute Polycythemia
Primary Polycythemia (PP) – Myeloproliferative disorder resulting in too many RBC in circulation
Secondary Appropriate Polycythemia (SAP) – increased RBC in response to chronic hypoxia
High altitude
Right to Left heart shunt
Lung Disease (poor ventilation)
VP mismatch – pulmonary hypertension
Secondary Inappropriate Polycythemia (SIP) – increased RBC due to increased EPO without systemic hypoxia
Paraneoplastic
Renal disease resulting in renal hypoxia (neoplasia, infection, inflammation, infarct, hydronephrosis, etc.)

4. Polycythemia Clinical Signs: exacerbated by exercise
Brain hypoxia – seizures, blindness, behavior changes
Peripheral hypoxia (positive feedback loop)
Lethargy, weakness, ataxia, tremors
Sequellae: hyperviscosity (doubled at HCT 70%)
Poor microcirculation
Local hypoxia
thrombosis

5. Sighthounds Higher reference values – increased red cell mass
HCT, Hb, RBC
Also increased MCV (macrocytosis)
RBC life span half of other dogs
Normally days
Sight Hounds days

6. Primary Polycythemia aka – polycythemia vera
aka – chronic red cell leukemia
aka – primary erythrocytosis
Dx - a diagnosis of exclusion
Bone marrow sampling not helpful to diagnosis, as erythroid hyperplasia is present with all absolute polycythemias
EPO levels normal
PCV often 70-80% despite fluid therapy

7. Secondary Appropriate Polycythemia
Clinical Signs:
Dyspnea or cyanosis
Differential cyanosis: restricted to rear of the body due to reverse PDA (rPDA)
Arterial blood gases: very low pO2, + high pCO2
Easier to get reliable results after phlebotomy
Pulse oximetry
<80% oxygen saturation
In rPDA, will be much lower on the rear of the dog or cat
CBC, profile, UA, chest rads, Abd US may show evidence of primary lung or heart disease

8. Secondary Inappropriate Polycythemia
Clinical Signs: same as primary polycythemia, due to hyperviscosity
Arterial blood gases: normal
Pulse oximetry: normal
CBC, profile, UA, chest rads, Abd US may show evidence of primary neoplasia or kidney disease
Most common offending tumors & diseases:
Any severe renal disease
Renal neoplasia
Leiomyoma/leiomyosarcoma
Endocrine tumors – benign or malignant
Liver tumors – benign or malignant

9. Renal disease can result in anemia *or* polycythemia
EPO Levels (Idexx)
In theory: should be high with SAP and normal with PP and SIP
However: only 50% of dogs with SAP have high EPO levels
If you get high EPO level, you have your diagnosis of SAP
Normal EPO level is not helpful in the polycythemic patient
Renal disease can result in
anemia *or* polycythemia

10. Arterial Blood Sample Megan Brashear, CVT, VTS (ECC)
Arterial blood gas collection using vented syringe
BD Arterial Blood Gas Kit 1cc, with vented syringe

11. Arterial Blood Sample Can also use a heparinized TB syringe
Most use femoral artery in the cat
dorsal pedal artery in the dog
lateral recumbency – sample the dependent leg
Palpate the pulse, clip and gentle alcohol or chlorhexidine prep – do not scrub
Prepare a TB syringe by drawing up 0.25cc heparin – 22g needle, coating entire syringe and squirting all air from the syringe and needle
Place 2 fingers of the non-dominant hand on the pulsing artery

12. Arterial Blood Sample
Use the dominant hand to direct the needle at a 60 degree angle into the artery
Through skin first, then advance into the artery
Syringe should fill with minimal negative pressure when in the artery
Withdraw needle and apply pressure for 5 minutes
Eliminate bubbles, apply
blood tube stopper to the
needle and keep on ice
Process immediately on
iSTAT, VetSTAT, HESKA

13. Summary PowerPoints .pptx .pdfs – 1 and 6 slides per page
Hidden Slides
EPO pathophysiology
Treatment of Polycythemia
Prognosis of Polycythemia
Hb Dissociation Curve
Diagnostic Algorithms - Polycythemia
Willard – polycythemia
Cases – Ginger – Reverse PDA

14. Acknowledgements Chapter 3: Erythrocytes Disorders
Douglass Weiss and Harold Tvedten
Small Animal Clinical Diagnosis by Laboratory Methods, eds Michael D Willard and Harold Tvedten, 5th Ed 2012
Chapter 60: Polycythemia
Andreas Hans Hasler
Textbook of Veterinary Internal Medicine, eds Stephen J Ettinger and Edward C Feldman, 6th Ed 2003