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Hormone

Conference

at Sahigren’s

University

Hospital:

Polycythemia

and Inappropriately

High Serum

Erythropoietin

CLIN. CHEM. 40/11, 2093-2098

(1994)

in a 62-Year-Old

Man

Concentration

G#{246}ran Lindstedt,”7

Per-Arne

Claes

Nordborg,6

and Bengt-Ake

Norrby,2

Lundberg,’ Bengtsson3

Anders

Jack

Kutti,3

Oluf

Andersen,4

Karl-Erik

Jakobsson,5

A 62-year-old complained symptoms concentration,

man with a history

of coronary

insufficiency

at

his

scheduled

visit

suggestive

of

gastritis.

to the His

outpatient clinic blood hemoglobin

however,

was

markedly

increased.

Results

of

of a hematological

work-up

suggested

an erythropoietin-

intracranial

pressure

tumor,

which could

This cystic

producing

tumor.

Signs

of increased

then led to

the finding

of a cerebellar

explain

his

vertigo and

abdominal

symptoms

.

vomiting troscopic patient’s and vertigo examination symptoms. preceding Gas- for the concentra- values were 1992-93. 3 weeks. over the revealed His blood no explanation hemoglobin previous g/L in increased platelet tion -150 sternal ropoiesis locyte 195 gIL (hematocrit 64%); 155-169 indicated Blood as were was g/L in bone and smear 1989-91 marrow A eryth- granu- iron were deficiency. normal, and and counts cobalamin serum

capillary

hemangiobiastoma

probably

was

responsible

for

the erythropoietin basic fibroblast

polycythemia

as well growth production factor. as erythropoietin The and also seemed clinical biochemistry to produce evaluation of and

clinicalapplication are reviewed.

Indexing

Terms:

iron

blast growth

factor/tumor

deficiency/differential markers/capillary

diagnosis/basic hemangioblastoma/cer-

fibro-

ebellar

tumor

This 5-year

Hormone history

Conference8 of coronary

deals insufficiency.

with

a

man with

His

complaints

a

now were

suggestive

of gastritis;

a markedly

increased

concentration

did

ations.

not

conform

with

the

of blood

hemoglobin

initial

diagnostic

consider-

however,

the

finding

of

Case Presentation

patient a nonsmoking to an outpatient 62-year-old clinic pain. The who pre- and man 5 years father was h a d b e e n a d m i viously because two brothers in cardiovascular t t e d of precordial chest His died before at age middle age 39 years). reportedly events had at or (one brother

Nitroglycerine was scheduled visit before

the

At

a

scheduled

ported

abdominal

was prescribed

for the

for semiannual

outpatient

present

complaints

was

visit

in January

1994

discomfort,

dyspepsia,

patient visits; in Ma

y

and he the last 1993.

the and

patient occasional

re-

Departments

of’

‘Medicine

(Division

ogy,

5Neurosurgery,

Clinical

Chemistry

of Endocrinology and 6Pathology

and Transfusion

Medicine,

and Hematology),4

Neurol-

at Gothenburg

University,

Sahlgren’s

University

Hospital,

S-413

45 Gothenburg,

Sweden,

‘Medical

Clinic,

Lundby

Hospital,

for correspondence.

Fax

S-417

  • +

    46

8Hormone at Gothenburg

conferences

University

at the Department

were

initiated

17 Gothenburg, 31 41 8994. of Clinical

Sweden.

Chemistry

in 1956 by Prof. Jorgen

Lehmann,

M.D., Ph.D.,

mainly

recognized

for the

pioneering

stud-

and

the treatment

with

4-aminosalicylic

accepted

August

of thrombosis acid 10, 1994. (2, 3).

ies of “sweet and of treating Received

clover

disease”

May

tuberculosis 12, 1994;

(1)

and erythrocyte centration

folate of serum

iron

concentrations, was low

and

whereas

the

total

iron-binding

con-

capacity The high. erythropoietin was serum concentration 3.7-16 lU/L 17 lUlL was (2nd Urinary [normal reference interval Interna- Eryth- tional Reference Preparation of Human concentration assay 67/343)]. ropoietin, This measured CoatRIA’’; detection fivefold of 2 1.tL of antibodies, high values procedures was (lmIEPO with an immunoradiometric BioM#{233}rieux SA, Lyon, France) with stated a limit of lU/L. 1 Values unchanged after were the addition heterophile falsely sample rat serum previously dilution as per tube observed well as after (to neutralize by us to give in in- method), both patients absence erythrocyte with this of analytical volume, 47 mllkg several dicating The interference. as measured by a 51Cr-label- (decision limit volume was polycythe- body weight ing method, as w body weight), (4). Thus, the 36 mL/kg normal whereas patient the plasma had absolute

out since diagnosis Group mia. Polycythemia could be ruled the as (5): vera patient did satisfy criteria for the the not established The spleen tosis or content cobalamin by the Polycythemia Study was the Vera (6); there neither activity increased. enlarged and phosphatase no leukocy- granulocyte the serum marrow hyperpla- concentration was not thrombocytosis; of alkaline nor Bone concentration was examination sia. Finally, did the megakaryocytic erythropoietin assay not reveal serum a high-detectability measured by rather high was

than low (7). The patient’s

history,

physical

examinations,

as well

as the

were

evidence

findings against

from the appropri-

(Table 1). or hepatic secondary polycythemia We ab- ate absolute therefore normality tocellular view attempted to demonstrate renal or dysfunction, in renal seemed patient’s or hepa- possible in polycy- particular, (Table 2), which carcinoma of the No rapid development of the themia. biochemical or morphological evidence was

CLINICAL

CHEMISTRY,

Vol. 40, No. 11, 1994

2093

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