Polyglobulie

The polyglobulie is a Symptôme defined by the increase in the absolute value of the number of érythrocyte S (or red globules ) circulating in the Sang. She answers two distinct mechanisms: the Polyglobulie primitive (or Maladie of Be occupied) is due to an anomaly of the original cells of the hematopoietic marrow which acquires tumoral characteristics which proliferate and involve an overproduction of red globules. The secondary Polyglobulie is, it, related to an increase in the blood rate of Hormone S stimulating the érythropoïèse, in particular EPO càd the érythropoïétine, generally secondary with a chronic Hypoxie (blood not being oxygenated enough, the tissue Ischémie causes a stimulation of the secretion of EPO by the Rein) or by inappropriate secretion of EPO. In this case, marrow is normal.

Diagnosis

Private clinic

The polyglobulie returns blood viscous, by increase in the mass of elements cellular circulating with the detriment of the plasma, which involves nonspecific signs:

  • Signs Neurological S: Cephalgia S, Giddiness S, buzzes of ears (Acouphène S), sometimes of the cerebral vascular accidents.
  • Signs Cutaneous S: érythrose cutaneous (the Peau is red).
  • arterial Hypertension.

Complementary examinations

  • the rate of Hématocrite is high: it exceeds 54% at the man, 47% at the woman.
  • the Sedimentation test (VS) is very low, to see null.
  • the diagnosis of certainty of polyglobulie (without prejudging its etiology) is the isotopic measurement of the globular mass to the chromium 51: it finds a globular mass higher than 36 ml/kg at the man, 32 at the woman.

Etiologies

Polyglobulies primitives

  • Maladie of Be occupied
  • essential Leucémie Myéloïde
  • Thrombocytémie

In the last both cases, the polyglobulie is not a crucial factor of the disease but it can appear within the framework of total medullary anomalies.

Polyglobulies secondaries

Secondaries with a chronic tissue hypoxia

The polyglobulies of this group are the consequence of a lowers pressure partial of oxygen in blood and represent a physiological demonstration of defense against the hypoxia . It seems that the erythropoietic hormone of the kidney serf of mediator to the reaction of medullary hyperplasy, which touches only the line érythroide. As these polyglobulies secondary with the anoxia is frequent, and as their treatment differs radically from that of the disease of Are occupied, it is important to know to differentiate them from this one.

During a fast rise a moderate degree of polyglobulie can occur in consequence of a contraction of spleen. It is only after several days or weeks of stay to high-altitude that the red hyperplasy of marrow ensures the relay. Many people, especially the feeble ones, adapt with difficulty to the rarefied air of high-altitudes and present the Mal mountains , which consists in fatigue, dyspnea, cephalgias (occipital), buzzes of ears, dazzlings, dizzy spells, giddinesses, nauseas, diarrheas, insomnia and frilosity. All these symptoms disappear in a few hours at lower altitude or by oxygen treatment.

Among certain inhabitants of high-altitudes (the Andes e.g.), one observes the development of a pulmonary hypertension and repeated respiratory infections, both generators of a chronic pulmonary heart (cardiac decompensation). The polyglobulie can then become very considerable (very viscous blood). This whole of facts constitutes the Maladie of Monge.

  • Méthémoglobinémie

Secondary with a hypersecretion of érythropoïétine (EPO)

Treatment

Separately the correction of the causal affection, the best form of treatment seems to consist of the Oxygénothérapie.

Polyglobulies associated with tumors

Most frequent are associated with renal tumors .

In the majority of the cases the tumors give place to polyglobulie appear to secrete érythropoéitine. These polyglobulies disappears by ablation from the tumor.

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