적혈구 증다증의 임상적 고찰

한지숙,이선주,남동기,강신욱,고윤웅 大韓血液學會 1990 大韓血液學會誌 Vol.25 No.1

Optimal Phlebotomy Interval to Change Hematocrit Levels in Patients with Polycythemia

이현지,신경화,송두열,이선민,김형회 대한수혈학회 2016 大韓輸血學會誌 Vol.27 No.3

Background: Phlebotomy is used to maintain hematocrit levels <45% to prevent polycythemia-related thrombotic events. However, guidelines for the phlebotomy intervals are lacking. Therefore, we analyzed post-phlebotomy changes in hematocrit and determined the optimal phlebotomy intervals for patients with polycythemia. Methods: Between March 2009 and August 2016, we performed 441 phlebotomies for 48 patients with polycythemia. Patients with high-risk polycythemia vera (PV) or secondary polycythemia with hypertension or arrhythmia were medicated with hydroxyurea. We divided the patients into three groups based on phlebotomy interval: <2 weeks, 2∼4 weeks, and >4 weeks. Results: No patients with secondary polycythemia and 25.8% of the patients with PV had thrombotic events pre-phlebotomy. Post-phlebotomy, none of the patients experienced a thrombotic event. The average decrease in hematocrit level was significantly different between the three groups, being 1.98±1.90% (<2 weeks), 0.73±2.53% (2∼4 weeks), and –0.46±4.80% (>4 weeks). Conclusion: To prevent thrombotic events, phlebotomy is a safe and effective treatment to reduce hematocrit levels in patients with polycythemia, regardless of medication. For the maximum effect, a <2-week phlebotomy interval to reduce and <4-week phlebotomy interval to maintain hematocrit levels could be effective.

적혈구증다증 환자의 사혈술 효과 평가

공정희,공선영,이세나,엄현석,이혜원,한지연,유헌,심효은 대한수혈학회 2013 大韓輸血學會誌 Vol.24 No.3

Background:Polycythemia vera (PV) is a myeloproliferative neoplasm that can cause complications such as thrombosis and organ damage. To prevent complications of PV, therapy for maintenance of a hematocrit target of less than 45% has been recommended and phlebotomy is a simple therapy. However, the effects of phlebotomy have not been well evaluated in Korea. Therefore, we evaluated the effects of phlebotomy performed in patients with PV and secondary polycythemia. Methods:The clinical data and phlebotomy records of 15 patients diagnosed with PV and secondary polycythemia from May 2005 to March 2013 at the National Cancer Center were reviewed retrospectively. Results:Patients included 10 males and five females. The median age of patients was 63 years (range, 50∼72 years). There were six PV patients (40%) and nine secondary polycythemia patients (60%). The mean number of phlebotomy attempts per patient was 6 (range, 1∼22), with an interval between phlebotomy attempts of 16 weeks (range, 1∼96 weeks). The mean phlebotomy volume was 458 mL, which was 10.3% of the total blood volume. After phlebotomy, the mean hematocrit showed a decline, from 50.4 (±4.35)% to 46.5 (±4.85)%, and symptoms improved. After phlebotomies, 10 patients achieved a hematocrit of less than 45% and this hematocrit level was obtained after an average of six phlebotomies. Conclusion:Phlebotomy is an effective treatment modality for lowering the hematocrit value in patients with PV and secondary polycythemia. However, target hematocrit was not achieved after a single phlebotomy. Therefore, adjustment of visit intervals and changes in phlebotomy volume were needed. 배경: 진성 적혈구증다증은 골수증식성질환으로 혈전증과 이에 따른 경색, 장기 손상 등의 부작용이 발생할 수 있다. 이를 예방하기 위해 목표헤마토크릿 수치를 45% 미만으로 정하여 치료를시행하는 것이 권장되고 사혈술은 모든 진성 적혈구증다증 환자에게 권장되는 간단한 치료법이다. 하지만, 국내에서 사혈술의 효과에 대한 평가가 잘 이루어져 있지 않아 본 연구에서는 국립암센터에서 시행된 적혈구증다증 환자의 사혈술의효과를 평가해보고자 하였다. 방법: 2005년 5월부터 2013년 3월까지 국립암센터에서 진성과 이차성을 포함한 적혈구증다증으로 진단된 환자 15명에게 시행된 95건의 사혈술을 대상으로 환자의 임상기록 및 사혈술 기록지를 조사하여 후향적으로 분석하였다. 결과: 적혈구증다증 환자는 남자 10명, 여자 5 명으로 중앙 연령은 63세(50∼72)였다. 진성적혈구증다증 환자는 6명(40%), 이차성 적혈구증다증환자는 9명(60%)이었다. 평균 사혈 횟수는 6회(1 ∼22)이고 평균 사혈술 시행 간격은 16주(1∼96) 이었다. 평균 1회 제거 혈액량은 458 mL로 총 혈액량의 10.3%이었다. 시술 전, 후 헤마토크릿은50.4% (±4.35)에서 46.5% (±4.85)로 유의하게 감소하였으며 피로, 두통, 어지러움증, 가려움증 등의 증상이 개선되었다. 환자들의 치료 방법은 사혈술 단독치료 환자는 6명(40%), 아스피린과 사혈술 병행 치료환자는 4명(27%), 아스피린, 하이드록시유레아, 사혈술이 병행된 환자는 4명(27%), 인터페론알파, 사혈술이 병행된 환자는 1 명(6%)이었다. 10명에서 시술 후 헤마토크릿 목표치인 45%가 되었으며 목표치 헤마토크릿 45% 도달까지 평균 6회의 시술이 시행되었다. 결론: 사혈술은 적혈구증다증 환자에서 헤마토크릿을 낮추는 효과적인 치료 방법이었다. 하지만, 한 번의 시술로 45% 미만의 헤마토크릿 목표치에 도달하는 경우는 드물기 때문에 효과적인사혈술을 위한 방문 기간의 조정, 1회 사혈량의증가 등의 고려가 필요할 것으로 판단되었다.

적혈구증가증의 감별진단

성화정 ( Hwa Jung Sung ) 대한내과학회 2020 대한내과학회지 Vol.95 No.1

Polycythemia could be defined as an elevation in hemoglobin or hematocrit levels above normal. To figure out what induces polycythemia is very important since the causes of polycythemia are very variable and the approaches for the treatments are basically different. Polycythemia can be primary or secondary in origin. The secondary causes are all associated with increase in erythropoietin (EPO) levels. If serum EPO levels are elevated, one try to differentiate whether the elevation is a physiologic response to hypoxemia or is related to autonomous production. Patients with low arterial O2 saturation (< 92%) should be further evaluated for the presence of heart or lung disease. Patients without hypoxemia who are smokers may have elevated EPO levels because of CO displacement of O₂. If carboxyhemoglobin levels are elevated, the diagnosis is smoker’s polycythemia. Patients without hypoxemia who do not smoke, either could be diagnosed as high oxygen affinity hemoglobinopathy or have EPO producing tumors. If EPO levels are low, the patients most likely have polycythemia vera which has almost JAK2 mutation. (Korean J Med 2020;95:27-30)

침치료로 임상증상이 호전된 진성적혈구증가증 환자 치험 1례

김어진,허소영,황조현,장은경,이장훈,김영철,Kim, Eujin,Hur, Soyoung,Hwang, Cho-Hyun,Jang, Eungyeong,Lee, Jang-Hoon,Kim, Youngchul 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.5

Objectives: This study investigated the effectiveness of acupuncture for improving polycythemia-vera-related symptoms and quality of life. Methods: A 56-year-old woman diagnosed with polycythemia vera received acupuncture treatment between February 19, 2021, and August 26, 2021. We observed the changes in subjective symptoms and conducted myeloproliferative neoplasm symptom assessment form total symptom score (MPN-SAF TSS) questionnaire. Results: After 13 acupuncture treatment sessions over six months, symptoms of polycythemia vera, such as fatigue, bone pain, itching, and headache, improved. Conclusion: This study suggests that acupuncture may be a helpful treatment strategy for polycythemia vera patients suffering from significant symptom burdens and reduced quality of life.

남성호르몬 보충요법에 의해 유발된 적혈구증가증: 장기지속형 주사형 테스토스테론 제제의 합병증

신동식,고기원,남상간,진명헌,김제종,문두건 대한남성과학회 2008 The World Journal of Men's Health Vol.26 No.4

Polycythemia is a condition in which the red blood cell count is increased due to an inherited or acquired mutation, a physiologic response to hypoxia, autonomous erythropoietin production, or deliberate erythropoietin administration. Higher testosterone levels appear to act as a stimulus for erythropoiesis and testosterone replacement therapies have rarely been reported as causes of polycythemia. We report here a case of a 51-year-old man with polycythemia that was caused by long-acting testosterone undecanoate (NebidoⓇ).

Noise Phobia-Induced Relative Polycythemia in a Dog

강민희,박희명 한국임상수의학회 2012 한국임상수의학회지 Vol.29 No.6

A 6-year-old castrated male Miniature Pinscher dog was referred due to shaking, panting and inappropriate elimination during thunderstorms. The dog had noise phobia after a car accident two years ago. The intensity of the fear of noise, especially with thunderstorms, worsened during the past 3 months (thunderstorm season). Physical examination revealed hyperthermia, tachypnea (panting), mild tachycardia, and an elevated systolic blood pressure. Laboratory examination revealed mild polycythemia with a lower oxygen pressure and saturation. Based on the history,physical examination, and laboratory tests, the dog was diagnosed as a noise phobia concurrent with relative polycythemia. Treatment was initiated with behavior modification with desensitization, counter-conditioning, and medication. Music therapy was also used and appeared to be beneficial. Clinical signs including polycythemia are improved. This case indicates that relative polycythemia can be occurred by chronic mental stress, such as noise phobia in a dog.

Hypercalcemia in a Patient with Polycythemia Vera

배은희,김현수,Min Jee Kim,Yong Un Kang,Yeong Hui Kim,김창성,Joon Seok Choi,마성권,김수완 전남대학교 의과학연구소 2012 전남의대학술지 Vol.48 No.2

A 59-year-old female with diabetes mellitus presented with hypercalcemia and polycythemia. Her serum calcium and intact parathyroid hormone (iPTH) levels were increased, and Tc-99m sesta-MIBI scanning showed hot uptake in the lower portion of the left thyroid lobe. After parathyroidectomy, her calcium, iPTH, and polycythemia were normalized. In conclusion, the differential diagnosis of polycythemia and hypercalcemia should also include the possibility of a parathyroid tumor in addition to other neoplasms.

Safety of delayed umbilical cord clamping in preterm neonates of less than 34 weeks of gestation: a randomized controlled trial

( Anubhuti Rana ),( Krishna Agarwal ),( Siddarth Ramji ),( Gauri Gandhi ),( Latika Sahu ) 대한산부인과학회 2018 Obstetrics & Gynecology Science Vol.61 No.6

Objective There is concern regarding the safety of delayed cord clamping (DCC) in babies born at less than 34 weeks' gestation. Therefore, the primary objective of this study was to compare the rates of hyperbilirubinemia and polycythemia during initial 7 days in infants born at less than 34 weeks' gestation and randomized to receive DCC by 120 seconds or early cord clamping (ECC) within less than 30 seconds. Methods One hundred pregnant women were randomly subjected to DCC or ECC at the time of birth in a tertiary referral hospital setting. Blood samples were obtained from each newborn at 48 hours and 7 days for hematocrit measurement. Serum bilirubin levels were estimated once the infant had clinically significant jaundice or at 72 hours. For the statistical analysis, the χ² test, Student's t-test, or Wilcoxon rank sum test was used. Results The hematocrit was significantly higher in the DCC group than in the ECC group (P<0.001). None of the babies had polycythemia. Mean total serum bilirubin level was 6.6 mg/dL in the DCC group and 8.7 mg/dL in the ECC group (P<0.001). There was no increased risk of hyperbilirubinemia in the DCC group. Conclusion DCC benefits preterm neonates with no significant adverse effects.

다혈구증을 동반한 두개강내 경막정맥동 혈전증 치험 1례 : Case Report

도병룡,백태진,이종광,김병준 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.2

Cerebral venous thrombosis is commonly related to infectious processes, trauma, neoplasm, puerperium, and the use of oral contraceptives, etc., but this case was associated with a very rare condition, "polycythemia." This case was confirmed by hematologic study, brain C-T, conventional angiography, and digital subtraction angiography(DSA). The patient was treated by venesection, the use of urokinase and dicumarol, and lumbo-peritoneal shunt(L-P shunt), etc. Post-treatment DSA showed the complete recanalization of all dural sinuses except the left transverse sinus, suggesting normal variant