MEDizzy - A 53-year-old man has had constant dull pain in his lower

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Combined Hematology II

A 53-year-old man has had constant dull pain in his lower right back for the past 4 months. On physical examination there is tenderness on percussion of his right costovertebral angle. An abdominal CT scan reveals a 6 cm mass in the upper pole of the right kidney. A CBC shows: Hgb 21.3 g/dL, Hct 64.0%, MCV 96 fL, platelet count 199,000/ microliter, and WBC count 8230/microliter. Serum chemistries include glucose 77 mg/dL, urea nitrogen 17 mg/dL, and creatinine 1.1 mg/dL. Which of the following is the most likely cause for his findings?

ExplanationD. This patient is having renal mass with high Hb which may be suggestive of some tumor of kidney which secretes erythropoietin and causes secondary polycythemia. Absolute erythrocytosis is seen in solitary renal cysts, polycystic renal disease or hydronephrosis. In patients with pheochromocytoma/paraganglionoma with erythrocytosis, erythropoietin assays of serum and urine shows higher than normal values, and is due to increased EPO production by the tumor cells