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MCC Examination Objectives Medical expertHemoglobin serum, abnormalElevated hemoglobin

Elevated hemoglobin

Version: February 2017
Legacy ID: 42-2

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).