Spurious Polycythemia

Spurious polycythemia is characterized by increased hematocrit and normal or decreased red blood cell (RBC) total mass. It results from decreasing plasma volume and subsequent hemoconcentration. This disease is also known as relative polycythemia, stress erythrocytosis, stress polycythemia, benign polycythemia. Gaisböck's syndrome, and pseudopolycythemia.

Causes

Possible causes of spurious polycythemia include the following:

dehydration. Conditions that promote severe fluid loss decrease plasma levels and lead to hemoconcentration. Such conditions include persistent vomiting or diarrhea, burns, adrenocortical insufficieny, aggressive diuretic therapy, decreased fluid intake, diabetic ketoacidosis, and renal disease.
hemoconcentration due to stress. Nervous stress leads to hemoconcentration by some unknown mechanism, possibly by temporarily decreasing circulating plasma volume or by vascular redistribution of erythrocytes.
high normal RBC mass and low normal plasma volume. In many patients, an increased hematocrit merely reflects a normally high RBC mass and low plasma volume.

Other factors that may be associated with spurious polycythemia include hypertension, thromboembolic disease, pregnancy, elevated serum cholesterol and uric acid levels, and familial tendency.

Diagnostic tests

Spurious polycythemia is distinguishable from true polycythemia vera by its characteristic normal or decreased RBC mass, elevated hematocrit, and the absence of leukocytosis.

Treatment

The principal goals of treatment are to correct dehydration and to prevent life-threatening thromboembolism. Rehydration with appropriate fluids and electrolytes is the primary therapy for spurious polycythemia secondary to dehydration. Therapy must also include appropriate measures to prevent continuing fluid loss.

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