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2022, Number 2

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Rev Hematol Mex 2022; 23 (2)

Post-phlebotomy microcytic erythrocytosis: A new clinical entity

Amaru R, Aguilar M, Velarde J, Mamani R, Patón D, Carrasco M

Language: Spanish
References: 49
Page: 91-98
PDF size: 243.65 Kb.


ABSTRACT

Objective: To describe microcytic erythrocytosis due to iron deficiency after frequent phlebotomies in patients with pathological erythrocytosis at high altitude.
Materials and Methods: A prospective longitudinal study that included patients with pathological erythrocytosis, all residing in La Paz and El Alto, Bolivia, at 3600 and 4000 masl, respectively. Three months after initiating phlebotomies aimed at reducing Hb levels, patients presented signs of iron deficiency and persistence of blood hyperviscosity. Clinical and laboratory studies were conducted to determine iron deficiency and microcytic erythrocytosis (MCV ‹ 75 fl, serum ferritin ‹ 15 ng/mL). Subsequently, intravenous iron saccharate 100 mg/day for 5 days in a group of patients, and polymaltose iron 100 mg/day orally for one month in other patients were administered.
Results: There were included 117 patients. Microcytosis (MCV: men 73.3 fl, women 72.5 fl), decreased serum ferritin (men 7.9 ng/mL, women 6.5 ng/mL) and persistence of hyperviscosity symptoms were observed. Treatment with intravenous iron showed an increased MCV and remission of hyperviscosity symptoms in 65% of patients. Simultaneously, treatment with oral iron increased MCV and decreased hyperviscosity symptoms (20%) gradually. Hemoglobin and hematocrit increased in both groups without reaching initial preflebotomy values.
Conclusions: Post-phlebotomy microcytic erythrocytosis is a new clinical entity secondary to iron loss due to frequent phlebotomies and can be treated with intravenous iron.


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