Hematocrit of 51.5% (HB 17.8 gr/dL) developed in a 71-year-old man who never smoked
and whose previous hematocrit values were 45.9-46.9% in 7 consecutive determinations.
Over the next 16 months, hematocrit gradually increased to 55.4% (HB 18.7 gr/dL),
with new-onset mild increase of cholestatic liver enzymes (Table 1). One year later, a hospital-based hematologist initiated extensive investigations.
White blood cell count (7.5 × 109/L) and platelets (190 × 109/L), glucose, electrolytes and proteins were normal; C-reactive protein 7.4 mg/dL
(N<5); Serum creatinine was 1.4 mg/dL, unchanged over years. Chest X-ray, abdominal
ultrasound and echocardiography were non-contributory. A search for a myeloproliferative
disorder or hypoxemia including sleep study was negative. Erythropoietin was 8.9 mIU/ml
(N 4.3-29). At last, computed tomography revealed multiple hepatic lesions and biopsy
showed cores of liver tissue infiltrated by metastatic adenocarcinoma morphologically
and immunohistochemically consistent with colonic origin. Carcinoembryonic antigen
(16 ng/ml, N<5) and CA-125 (42 U/ml, N<35) was increased. PET CT demonstrated extensive
hypermetabolic lesions in the liver and a peripancreatic lymph node.
Table 1Changes in the patient's hemoglobin, hematocrit, acute-phase reactants, and cholestatic
enzymes over 19 months.
| At RightHemicolectomyT2N0M0 | After 14 months | After 16 month | After 25 months | After 30 monthsAt Diagnosis of Liver Metastases | |
|---|---|---|---|---|---|
| Hb, g/dL N 13.5-16.5 |
14.6 | 16.8 | 17.8 | 18.7 | 17.5 |
| Hematocrit, % N 38-50 |
44.3 | 51.5 | 53.5 | 55.3 | 54.7 |
| Ferritin, ng/ml N 22-275 |
104 | ND | ND | 50.1 | 244 |
| CRP, mg/L N 0-5 |
2.3 | ND | ND | 5.6 | 7.4 |
| Alkaline Phosphatase, U/L N 30-140 |
108 | 185 | 173 | 164 | 180 |
| Gamma-Glutamyl Transferase, IU/L N 9-55 |
35 | ND | 81 | ND | 76 |
^ Values in this column remained stable over 13 months. Transaminases and bilirubin
were always normal. Abnormal results are underlined.
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