Secondary Polycythaemia in COPD — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareSecondary Polycythaemia in COPDSCE Palliative Medicine

A 74-year-old man with end-stage COPD and chronic hypoxia develops secondary polycythaemia (haemoglobin 190 g/L, haematocrit 0.58). He suffers with headaches and visual disturbance consistent with hyperviscosity. What is the most appropriate management?

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Correct answer: E — Venesection to reduce haematocrit to <0.55, plus optimisation of long-term oxygen therapy to reduce hypoxic erythropoietin drive

This patient's haematocrit of 0.58 exceeds the BSH‑recommended threshold (>0.56) for venesection in hypoxic lung disease; reducing haematocrit to <0.55 alleviates symptoms of hyperviscosity. Optimising long‑term oxygen therapy also addresses the pathophysiological hypoxic drive to erythropoiesis. Oxygen alone (Option B) lacks rapid symptomatic relief. Hydroxyurea (Option C) is for clonal myeloproliferative disease, not secondary erythrocytosis. Elevated haemoglobin is not protective here—the hyperviscosity worsens microcirculation (Option D). Aspirin alone (Option E) does not treat hyperviscosity or erythropoietic stimulus.

Reference: British Society for Haematology guideline: A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis (2018); plus NICE QS10 on long‑term oxygen therapy (2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6519221/