Does it always add up?

I met a young man last night who’d had one of those sudden collapses for no obvious reason.

The family said he was very flushed, complaining of being very hot then, quite out of the blue, he collapsed. By the time I and the crew arrived he was sitting in a chair, looking pale and unwell. We ran all the usual tests – nothing showed up. He’d had a recent chest infection but his chest was clear now. Even so, the whole family was on edge. It was apparent that something else was bothering them. I put the point to Mum. “Is there something in particular you’re worried about?”

Then it all came out. An older family member had died from polycythaemia some years earlier (a condition in which there is a net increase in the total circulating erythrocyte (red blood cell) mass of the body). I’d never heard of it but they were concerned because the initial symptoms had been the same. (It can also be secondary to various respiratory disorders* – The chest infection?) Were they overreacting? Was this a case of 2 + 2 = 5? Certainly none of us had any idea so we all agreed that it was probably best, if only to reassure everyone, that the crew pop him up to A&E.

Later in the night I was up in A&E with another patient and I spotted the gentleman in one of the cubicles. I went over to see how things were going. He certainly looked a lot better, though his posture suggested he still didn’t feel right.

“They’ve not managed to find anything”, he said.

I spotted the cannula in his arm. “Have they done some blood tests as well?”

“Yes. They said my haemo-something-or-other was very high.”

I wonder, did he mean heamatocrit? If so, then perhaps there was reason for him and the family to be concerned. The info says:

“In primary polycythemia, there may be 8 to 9 million and occasionally 11 million erythrocytes per cubic millimeter of blood (a normal range for adults is 4-6), and the hematocrit may be as high as 70 to 80%”

I hope it was nothing and just a case of him being a little stressed.

*Oxford concise medical dictionary


One Response to Overreaction?

  1. Rob says:

    I was doing a case study on polycythaemia the other day! It occurs in animals too – in our case we think we had dog with secondary polycythaemia due to a liver tumour. Very interesting case, but quite rare.

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