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Referral
Increased Haemoglobin
Scope
Elevated haemoglobin and haematocrit levels can reflect decreased plasma volume (due to dehydration, alcohol, smoking, diuretics) or increased red cell mass (polycythaemia).
Polycythaemia may be secondary (usually to chronic hypoxia from chronic lung disease, but occasionally to erythropoietin-secreting tumours, especially renal tumours, fibroids) or primary (polycythaemia vera).
Primary polycythaemia or polycythaemia vera (PV):
- often has splenomegaly and increased white cell counts and platelets
- is a myeloproliferative neoplasm and is mostly associated with a Janus Kinase 2 (JAK2) mutation
- occurs in adults, between 50 and 70 years
- is associated with an increased incidence of venous and arterial thromboses
- may progress onto other disorders such as acute leukaemia or myelofibrosis
History and Examination
Consider history:
- Thrombosis or vascular event
- Respiratory or renal disease
- Examine every patient for splenomegaly, as this is a key diagnostic criteria for polycythaemia vera (PV)
Evidence of thrombosis or vascular event and raised haematocrit greater than 0.52 (males) or greater than 0.48 (females) warrants acute medical admission
- Renal function, Midstream urine, ferritin, O2 saturation (chronic hypoxia is the most common cause of secondary PV)
- Neutrophila and thrombocytosis are often seen with primary PV
Referral Criteria
If raised haematocrit greater than 0.52 (males) or greater than 0.48 (females) and evidence of:
- thrombosis, vascular event, or other haematological abnormalities, arrange an acute general medicine assessment
- respiratory or another secondary cause, treat and manage
- if associated neutrophilia and/or thrombocytosis refer to haematology
- if raised haemoglobin level persists and no secondary cause found refer to haematology for further assessment
Urgent or written haematology advice is available
Referral Instructions
e-Referral Service Selection
- Specialty: Haematology
- Clinic Type: Not Otherwise Specified
- Service: DRSS-South Devon & Torbay-Haematology- Devon ICB - 15N
Referral Forms
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication Date: September 2017
