In some patients the bone marrow eventually becomes fibrotic hematopoiesis

In some patients the bone marrow eventually becomes

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In some patients, the bone marrow eventually becomes fibrotic, hematopoiesis develops in the spleen, and anemia follows. In a few patients, acute myeloblastic leukemia develops in the later stages, especially if treatment has involved chemotherapy.
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9/26/18, 5*38 PM Page 61 of 74 Etiology Primary polycythemia is a neoplastic disorder of unknown origin that commonly develops between the ages of 40 and 60 years, although younger individuals can be affected. Secondary polycythemia may be a compensation mechanism intended to provide increased oxygen transport in the presence of chronic lung disease or heart disease or from living at high altitudes. Some cases result from erythropoietin-secreting tumors such as renal carcinoma. Signs and Symptoms The patient appears plethoric plethoric and cyanotic cyanotic, with the deep bluish-red tone of the skin and mucosa resulting from the engorged blood vessels and sluggish blood flow. Hepatomegaly Hepatomegaly , an enlarged liver, and splenomegaly are present. Pruritus is common. Blood pressure increases, the pulse is full and bounding, and dyspnea, headaches, or visual disturbances are common. Thromboses and infarctions may affect the extremities, liver, or kidneys as well as the brain or the heart. Congestive heart failure frequently develops because of the increased work load resulting from the increased volume and viscosity of blood. High levels of uric acid resulting from cell destruction result in severe joint pain. Diagnostic Tests Cell counts are increased, as are hemoglobin values, and hematocrit is elevated. In polycythemia vera, the malignant or abnormal cell is the erythrocyte. Bone marrow is hypercellular, with the red marrow replacing some fatty marrow. Hyperuricemia is present because of the high cell destruction rate.
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9/26/18, 5*38 PM Page 62 of 74 PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be reproduced or transmitted without publisher's prior permission. Violators will be prosecuted. Treatment Drugs or radiation may be used to suppress the activity of the bone marrow. There is significant risk that fibrosis or leukemia may develop with these methods. Periodic phlebotomy phlebotomy , or removal of blood, may be used to minimize the possibility of thromboses or hemorrhages. 10-8 Think about Compare the general effects of anemia and polycythemia in terms of hemoglobin level, hematocrit, general appearance, and possible complications. The Leukemias The leukemias are a group of neoplastic disorders involving the white blood cells. The estimated number of new cases of leukemia each year is 31,000 including 2500 children.
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