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DR. GEORGE N. BEDELL: The purpose of this conference is to discuss some of the problems encountered in the differential diagnosis of polycythemia. Poly-cythemia may be a manifestation of heart disease, lung disease, or a primary blood dyscrasia. Polycythemia vera is a disease of unknown cause. In our hospital we make a diagnosis of polyeythemia vera on the basis of finding leukocytosis, high platelet count, and splenomegaly in addition to polycythe-mia. We require exclusion of conditions capable of producing secondary polycythe-mia, such as cyanotic heart disease, lung disease, chronic exposure to high altitude, and respiratory center depression. Secondary polyeythemia is diagnosed when the patient has polycythemia associated with cyanotic heart disease or lung disease in the absence of leukoeytosis, high platelet count, and splenic enlargement. The differentiation of polycythemia vera from secondary poly-cythemia is sometimes a difficult task. Ratto, Briscoe, Morton, and Comroel have discussed the theoretical reasons that make this distinction possible by measuring arterial oxygen saturation. Also they point out the practical obstacles. The hypothesis is that uncomplicated polycythemia vera should not lead to arterial hypoxemia. No disturbance in pulmonary ventilation, pulmonary circulation , or in the ability of oxygen to diffuse from the alveolus into the red blood cell has been demonstrated in patients with polyey-themia vera. If the oxygen saturation of arterial blood is reduced in patients with polyeythemia, this suggests that polycythe-mia is secondary to hypoxemia. This con-elusion is questionable because arterial oxygen desaturation may exist from other causes: 1. Patients with polyeythemia vera are usually more than 50 years of age. Healthy persons of this age may have slight reduction of arterial oxygen saturation.2 2. Patients with polyeythemia vera may have concomitant lung disease to account for arterial hypoxemia. 3. Most patients with polyey-themia vera whose arterial blood has been studied have no hypoxemia,1 3 however, arterial hypoxemia has been reported in poly-cythemia vera.4-6 We believe that arterial desaturation in the polyeythemic patient is evidence that polyeythemia vera exists with another disease or that polyeythemia is secondary to another disease. The following cases have been chosen to illustrate how the patient with polyeythemia can be studied to evaluate his basic disease. CASE 1 Mr. C. K., a 49-year-old farmer, was admitted to the University Hospitals on January 6, 1956. He was active and able to do his work until De-cember 1955. At that time, coughing, dyspnea on exertion, and hemoptysis began. His nails had …

Polycythemia: A Manifestation of Heart Disease, Lung Disease or a Primary Blood Dyscrasia