Jump to comment:
- Page navigation anchor for RE: CMAJ August 10, 2020 192 (32) E913-E918RE: CMAJ August 10, 2020 192 (32) E913-E918
Figure 1 indicates that Polycythemia Vera can be diagnosed without a bone marrow biopsy. Per Swerdlow et al., (2017), a bone marrow biopsy showing age-adjusted hypercellularity and panymyelosis is required for a diagonsis of Polycythemia Vera to be made.
Competing Interests: None declared.References
- Siraj Mithoowani, Marissa Laureano, Mark A. Crowther, et al. Investigation and management of erythrocytosis. CMAJ 2020;192:E913-E918.
- Swerdlow, SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds): WHO Classificatio nof Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition). IARC: Lyon 2017
- Page navigation anchor for RE: SGLT2 Inhibitor-Induced ErythrocytosisRE: SGLT2 Inhibitor-Induced Erythrocytosis
We thank Dr. Mithoowani and colleagues for their excellent review on the investigation and management of erythrocytosis (1), which provides a comprehensive overview and approach to a common presentation encountered by hematologists and general practitioners alike.
One additional drug-associated cause of secondary erythrocytosis of increasing relevance in general practice is the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors. With the growing use of this class of medications in Canada, on the basis of mounting evidence for improved cardiovascular outcomes in type 2 diabetes and heart failure, SGLT2 inhibitors are worth including in the already extensive differential for secondary erythrocytosis offered by Mithoowani et al. in their article (1).
At our centre, we have noted an increase in the number of referrals of patients with erythrocytosis on SGLT2 inhibitors, which often resolves following discontinuation of these medications. Increases in hematocrit were noted in initial clinical trials of SGLT2 inhibitors, and were thought to account in part for the cardioprotective effects of these medications. The physiology of SGLT2 inhibitor-induced erythrocytosis is complex and remains to be fully elucidated but postulated mechanisms include hemoconcentration, modulation of iron metabolism, and increased erythropoietin production, as recently demonstrated in a Canadian study (2).
To date, we are aware of a total of five cases of severe erythrocytos...
Show MoreCompeting Interests: None declared.References
- 1. Siraj Mithoowani, Marissa Laureano, Mark A. Crowther, et al. Investigation and management of erythrocytosis. CMAJ 2020;192:E913-E918.
- 2. Mazer CD, Hare GMT, Connelly PW et al. Effect of Empagliflozin on Erythropoietin Levels, Iron Stores, and Red Blood Cell Morphology in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease. Circulation 2020;141(8):704-707.
- 3. Das L, Bhansali A, Walia R. Unmasking and aggravation of polycythemia vera by canagliflozin. Diabet Med. 2018;35:1613-1616.
- 4. Motta G, Zavattaro M, Romeo F, Lanfranco F, Broglio F. Risk of Erythrocytosis During Concomitant Testosterone and SGLT2-Inhibitor Treatment: A Warning From Two Clinical Cases. J Clin Endocrinol Metab. 2019;104:819-822.
- 5. Gupta R, Gupta A, Shrikhande M, Tyagi K, Ghosh A, Misra A. Marked erythrocytosis during treatment with sodium glucose cotransporter-2 inhibitors-report of two cases. Diabetes Res Clin Pract. 2020;162:108127.