Treatment of Secondary Polycythemia in COPD When Hypoxia Management Has Not Reduced the Haematocrit
This protocol addresses patients with chronic obstructive pulmonary disease (COPD) who have erythrocytosis with haematocrit above 0.55, and in whom treatment of the underlying hypoxia has not achieved haematocrit reduction.
Erythrocytosis is a recognised complication of advanced COPD. In COPD, the incidence of erythrocytosis — usually defined as haematocrit above 0.55 — ranges from 6 to 8%. Symptomatic hyperviscosity and impaired exercise tolerance are the key clinical concerns in this setting.
The first-line approach is to address the underlying hypoxia: evaluation for long-term oxygen therapy, smoking cessation, and consideration of nocturnal non-invasive ventilation. The intended goal is reduction of the haematocrit through correction of the hypoxic drive. This protocol applies when that goal has not been achieved.
When clinical criteria are met, venesection is the procedure used to address the elevated haematocrit. The full protocol specifies the exact criteria for intervention, the monitoring targets, and the exercise-tolerance endpoint used to define an adequate response.
- Erythrocytosis can be associated with advanced chronic obstructive pulmonary disease (COPD) and with obstructive sleep apnoea syndrome (OSA).
- In COPD, the incidence of erythrocytosis, usually defined as Hct > 055, ranges from 6 to 8%.
- Patients who are symptomatic as a result of hyperviscosity or have a Hct >056 should be considered for venesection to reduce this to 050–052.
- Reducing the Hct to 050–052 led to an improvement in exercise tolerance but a further staged reduction of Hct to 045 did not give additional benefit.