Simultaneous occurrence of multiple aetiologies of polycythaemia: renal cell carcinoma, sleep apnoea syndrome, and relative polycythaemia in a smoker with masked polycythaemia rubera vera

摘要

A 58 year old male heavy smoker pre- sented with intracranial hamorrhage and erythrocytosis. Four aetiologies of polycythaemia-polycythaemia rubra vera (PRV), renal cell carcinoma, sleep apnoea syndrome, and relative polycythaemia-were found to be associ- ated with the underlying causes of eryth- rocytosis. He did not fulfill the diagnostic criteria for PRV at initial presentation, but an erythropoietin independent eryth- roid progenitor assay identified the masked PRV, and the low post- phlebotomy erythropoietin concentration also suggested the likelihood of PRV evolution. This case demonstrates that a search for all the possible causes of ryth- rocytosis is warranted in patients who already have one aetiology of polycythae- mai.