Brian Sumner

EM@3AM: Polycythemia

A 63-year-old male without any past medical history presents to the emergency department with several weeks of headaches, some blurry vision while walking at a quick pace, and shortness of breath. His last checkup with his primary doctor was about 3 years ago and everything was ‘normal’. He takes no medications, has no allergies, and has no previous surgeries. He admits to being a long-term smoker, about a half a pack a day for 20 years. Examination in the ED is normal. Basic lab work is drawn which reveals a hematocrit of 63%, elevated RBC mass, and thrombocytosis to 550K/ml. On further evaluation as an inpatient, it was found the patient had a low erythropoietin level. What is the diagnosis? 

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