Elevated hemoglobin

Rationale

Elevated hemoglobin levels may be a manifestation of polycythemia vera or secondary erythrocytosis. Elevated hemoglobin levels may be due to many treatable causes. Unrecognized polycythemia may cause end-organ damage.

Causal Conditions

(list not exhaustive)

1. Red cell mass increased
   1. Polycythemia vera – low or normal erythropoetin (EPO)
   2. Secondary erythrocytosis – elevated EPO
      1. Appropriate EPO elevation (e.g., hypoxemia)
      2. Inappropriate EPO elevation (e.g., EPO secreting tumour)
   3. Relative polycythemia (decreased plasma volume)

Key Objectives

Given a patient with elevated hemoglobin levels, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with elevated hemoglobin level, the candidate will

1. list and interpret critical clinical findings, including
   1. differentiating between primary and secondary erythrocytosis;
   2. assessing the presence of complications;
2. list and interpret critical investigations, including
   1. appropriate laboratory and diagnostic imaging;
3. construct an effective initial management plan, including
   1. referring the patient for specialized care, if necessary;
   2. counselling and education (e.g., smoking cessation, work environment).