1900 METRE RAKIMDA HEMOGLOBİN YÜKSEKLİĞİ NEDENİ İLE BAŞVURAN OLGULARIN ETİYOLOJİSİ: TEK MERKEZ DENEYİMİ

AMAÇ: Hemoglobin yüksekliğinin nedenleri primer, sekonder ve idyopatik olup; en önemli sekonder nedenlerden birisi yüksek rakımdır. Biz bu çalışmada 1900 metre rakımda olan Erzurum ilinde, hematoloji polikliniğine hemoglobin yüksekliği nedeniyle başvuran hastaların etiyolojik nedenlerinin araştırılmasını amaçladık. GEREÇ VE YÖNTEM: Çalışmamıza 180 hasta dahil edildi. Dünya Sağlık Örgütü’nün yayınladığı polisitemia vera tanı kriterlerine uygun olarak; hemoglobin değeri kadınlarda >16 g/ dl, erkeklerde >16,5 g/dl ise yüksek olarak kabul edildi. Hastaların dosyaları retrospektif olarak incelendi ve yaş, cinsiyet, hemogram parametreleri, eritropoietin değeri, dalak boyutu, JAK2 mutasyon varlığı, kemik iliği biyopsi sonuçları, komorbid hastalıkları ve sigara alışkanlığı kaydedildi. BULGULAR: Olguların yaş ortalaması 50,35±15,97 olup; 50 (%27,8) olgu kadın, 130 (%72,2) olgu erkek idi. Olguların 176’sın da (%97,8) mutlak, 4’ün de (%2,2) rölatif hemoglobin yüksekliği saptandı. Hemoglobin değerinin üst sınırı rakıma göre düzeltildiğinde 12 (%6,7) kadın, 16 (%8,9) erkek olgunun hemoglobin değeri normaldi. Olguların 17’sin de (%9,4) polisitemia vera, 152’sin de (%84,4) sekonder polisitemi saptanırken; 7 (%3,9) olgu idyopatik olarak değerlendirildi. 15 (%8,3) olguda JAK2V617F, 1 (%0,6) olguda ekson 12 pozitif idi. SONUÇ: Yüksek rakımda bulunan yerleşim yerlerinde, hemoglobin değerinin rakıma göre düzeltilerek ileri tetkike karar verilmesi, gereksiz tetkik yapılmasını engelleyip maliyeti azaltabilir.

ETIOLOGY OF PATIENTS WHO ADMINISTERED BY THE ELEVATED HEMOGLOBIN LEVEL AT 1900 METER RAKIM: ONE CENTER EXPERIENCE

AIM: The causes of elevated hemoglobin are primary, secondary and idiopathic; one of the most important secondary reasons is high altitude. We aimed to investigate the etiological causes of patients who applied to the hematology outpatient clinic because of the elevated hemoglobin in Erzurum (1900 meters). MATERIAL AND METHOD: 180 patients were included in our study. In accordance with the diagnostic criteria of polycythemia vera published by the World Health Organization; hemoglobin value was considered high if >16 g/dl in women and >16.5 g/dl in men. The files of the patients were analyzed retrospectively and the age, gender, hemogram parameters, erythropoietin level, spleen size, the presence of JAK2 mutation, bone marrow biopsy findings, comorbid diseases and smoking habit were recorded. RESULTS: The mean age of the patients was 50.35±15.97, 50 (27.8%) of them were women and 130 (72.2%) were men. Absolute and relative hemoglobin elevation were determined in 176 (97.8%) cases and 4 (2.2%) cases, respectively. When the upper limit of hemoglobin value was corrected for altitude, 12 (6.7%) female and 16 (8.9%) male cases had normal hemoglobin value. While polycythemia vera was detected in 17 (9.4%) of all cases and secondary polycythemia in 152 (84.4%) of all cases; seven (3.9%) cases were evaluated idiopathically. JAK2V617F was positive in 15 (8.3%) cases and exon 12 positive in 1 (0.6%) case. CONCLUSION: In cities at high altitudes, the correction of the hemoglobin value according to the altitude and the decision for further investigation can prevent unnecessary investigations and reduce the cost.

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