Hematocrit of 51.5% (hemoglobin 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% (hemoglobin 18.7
gr/dL), with new-onset mild increase of cholestatic liver enzymes (Table). 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 was 7.4 mg/dL
(N <5); Serum creatinine was 1.4 mg/dL, unchanged over years. Chest X-ray study, abdominal
ultrasound, and echocardiography were noncontributory. 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. Positron emission
tomography-computed tomography demonstrated extensive hypermetabolic lesions in the
liver and a peripancreatic lymph node.
Values in this column remained stable over 13 months. Transaminases and bilirubin
were always normal. Abnormal results are underlined.
TableChanges in the Patient's Hemoglobin, Hematocrit, Acute-Phase Reactants, and Cholestatic
Enzymes Over 19 Months
| At Right Hemicolectomy, T2N0M0 |
After 14 Months | After 16 Months | After 25 Months | After 30 Months. At 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 |
† Post-phlebotomy.CRP = C-reactive protein; Hb = hemoglobin; ND = Not done.
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Article info
Publication history
Published online: November 06, 2022
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In Press Journal Pre-ProofFootnotes
Funding: None applicable.
Conflicts of Interest: None identified.
Authorship: The sole author is responsible for all content.
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