Causes of Acquired Polycythemia

• Generalized or localized tissue hypoxia
  • Generalized
    • high altitudes
    • COPD
    • Alveolar hypoventilation/Obstructive Sleep apnea or Obesity (Pickwickian syndrome).
    • Right-to-left shunt/Congenital heart disease
      
    • High affinity hemoglobinopathy. Carbon monoxide poisoning (causes formation of carboxyhemoglobin which has a strong affinity for oxygen.)
  • Decreased perfusion of the kidneys, which may lead to stimulation of erythropoietin
    
    • Arteriosclerosis
    • Renal transplantation
      
    • Aneurysms of the aorta and renal vessels
    
    
• Inappropriate stimulation of EPO production
  • Hydronephrosis and cysts, can stimulate erythropoietin production
  • Malignant and benign tumors that secrete erythropoietin e.g. renal carcinomas and cerebellar hemangioblastomas
  • Blood doping(competitive sportsman)
  • Androgenic steroid use.
  • Congenital causes of high erythropoietin e.g. in von Hippel-Lindau syundrome
  
  
• Low EPO-dependent polycythemias
  • These are called primary familial and congenital polycythemias.⁹
  • The EPO receptor mutation results in a gain of function, and patients have normal-to-high hematocrit values and low EPO levels.¹⁰
  • These conditions can be acquired from (1) insulinlike growth factor-1 (IGF-1), a well-known stimulator of erythropoiesis, and (2) cobalt toxicity, which can induce erythropoiesis.