SHM Converge Scientific Abstract ePoster Gallery-Bloodletting: Modern Use of an Ancient Treatment for Hypoxemia

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This case describes a 73-year-old man with hypertension, BPH, GERD, and latent tuberculosis who presented with 4 days of chills, dyspnea, diarrhea, and dysuria. On arrival, he was hypoxemic (SpO2 88% on room air) and required high-flow oxygen, yet he remained comfortable, with clear lungs and a broad negative pulmonary workup. Chest x-ray and CTA showed only mild atelectasis, V/Q scan was low probability for PE, echocardiogram showed no shunt, and methemoglobin was normal. Infectious testing revealed E. coli UTI and enteroaggregative E. coli gastroenteritis, which were treated with antibiotics.<br /><br />Despite treatment, he had severe hypoxemia with a markedly elevated A-a gradient and minimal response to oxygen. Notably, he also had marked erythrocytosis (Hgb 20.2 g/dL, Hct 58%) with low serum erythropoietin (2 mU/mL), raising concern for a primary erythrocytosis such as polycythemia vera. JAK2 testing was negative, but bone marrow biopsy was recommended. His hemoglobin and hematocrit gradually decreased during hospitalization, including after a 500 mL therapeutic phlebotomy performed on hospital day 9. Soon afterward, his oxygen requirement improved, and he was weaned to room air by discharge.<br /><br />The authors conclude that his hypoxemia was most likely driven by hyperviscosity from erythrocytosis, rather than cardiopulmonary disease. This case highlights therapeutic phlebotomy as a modern treatment for ancient bloodletting, particularly in polycythemia vera, where lowering hematocrit can reduce viscosity, improve oxygen delivery, and lower thrombotic risk. He was discharged on aspirin with hematology follow-up.

Asset Subtitle

Grace Armstrong

Meta Tag

Author List Alexandra A. Wick, Grace Armstrong

Category Clinical Vignettes

Concept Hypoxemia

Concept Testosterone-Induced Polycythemia

Concept Polycythemia Vera

Concept A-a gradient

Concept Erythropoietin

Distinguished Non-Finalist

Presenter Organization University of Wisconsin School of Medicine and Public Health

Presenting Author Grace Armstrong

Track Adult

Keywords

hypoxemia

erythrocytosis

polycythemia vera

hyperviscosity

therapeutic phlebotomy

low erythropoietin

JAK2 negative

A-a gradient

E. coli infection

oxygen requirement

Hypoxemia

Testosterone-Induced Polycythemia

Polycythemia Vera

A-a gradient

Erythropoietin