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Secondary Polycythaemia — RACP Adult Medicine MCQ

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HardHaematologySecondary PolycythaemiaRACP Adult Medicine

A stable patient with severe COPD has PaO2 57 mmHg on repeated room-air arterial gases, haemoglobin 182 g/L, elevated erythropoietin and no JAK2 mutation. Which intervention best addresses the driver of erythrocytosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Prescribe long-term oxygen after COPD optimisation and formal home-oxygen safety assessment

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · A = shown as D

D is correct because stable PaO2 55–59 mmHg with polycythaemia meets an Australian long-term oxygen criterion after optimal therapy and safety assessment; correcting hypoxia treats the erythropoietin drive. E may be considered only for selected hyperviscosity and should not normalise haematocrit or replace oxygen. A ignores the secondary phenotype. B does not reproduce sustained therapy. C uses the wrong threshold and ignores a qualifying complication.

Reference: RACGP, Therapeutic venesection and erythrocytosis: https://www.racgp.org.au/afp/2017/march/performing-therapeutic-venesection-in-a-doctor-s-s; COPD-X, Oxygen therapy: https://copdx.org.au/copd-x-plan/p-prevent-deterioration/p10-oxygen-therapy/