This is an update to previous case of 23 yr male(Tagging the case below) ... In the previous blood report it showed mild elevation of basophills, lymphocytes, rbc and haemoglobin..which made the diagnosis suspicious to polycythemia vera.... Now another report from another centre is showing normal values.. And suggested SERUM EPO test(not done before) is normal as well.... Kft and other tests are also normal... Now how to proceed further... As one lab report made diagnosis suspicious to polycythemia vera..and other lab reports came to be normal... Pls do comment ur opinion doctors. . Thank u

(Edited)

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We need to always repeat laboratory tests if in doubt. In this case patient must be having viral infection or atypical infection.. lead to such anomalies. Just observe the patient and also get the test repeated for CBC with Ferritin and TIBC reports at two labs on same time. Just give symptomatic treatment at present.

Thank you doctor
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Polycythemia Vera is a myeloproliferative neoplasm and in addition to a high Hb, can present with high platelet count and left shift. EPO is generally low-low normal with PCV. To make a diagnosis of PCV one needs to meet WHO criteria (https://www.mpnconnect.com/pdf/who-diagnostic-criteria-mf-pv-et.pdf ). This person does not meet that criteria currently. Hb can also be increased is drawn after exercise, dehydration etc. If you are super worried get another CBC in a month, and if still high you can order JAK mutation (can be done on peripheral blood, does not need a bone marrow biopsy). 97% patients with PCV will have JAK mutation. PCV is a chronic disorder so 1 month will not make much of a difference honsetly.

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As your pt has this problem during lockdown,as there is no exercise in Jim and plenty of work for food only,so he might have started increase in wt. As one of Dr put doubt, u go in detailed hx as was he taking anabolic steroids? Many Jimmer r taking without medical supervision. Go for Bone marrow to go in deep for correct diagnosis

Thank you doctor
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Though both labs are of different opinions only adv can be given cross check before asking an opinion from colleagues we need to reply what you post hence always cross check

@Dr. Shivraj Agarwal sir i tagged the case below for cross check
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Cross check

Its just tachycardia due to tension Now check vital sign and complaint of patient