Incidence of Polycythaemia in Pancreatitis Patients

Acute pancreatitis is the in(cid:976)lammation of the pancreas due to reversible parenchymal injury. It is clinically diagnosed by a characteristic abdominal pain and laboratory (cid:976)indings of elevated levels of serum amylase and serum lipase. In addition to this, due to the movement of the intravascular (cid:976)luid into the abdominal cavity, polycythaemia has been observed in a few such patients, which can potentially predispose to thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), thereby posing a life-threatening risk to the patient. A study was conducted in the Department of General Surgery at Saveetha Medical College and Hospital to assess the incidence of polycythaemia in patients clinically diagnosed with acute pancreatitis by retrospectively analysing the haematology reports of 50 patients. It was found that 5 out of 50 patients (10%) had a (cid:976)inding of polycythaemia in their haematology reports. The identi(cid:976)ication of polycythaemia in pancreatitis patients will help the clinician with the management protocol to prevent the occurrence of thromboembolic events.


Polycythaemia, Pancreatitis, Intravascular Volume Depletion, Thromboembolism
A Acute pancreatitis is the in lammation of the pancreas due to reversible parenchymal injury. It is clinically diagnosed by a characteristic abdominal pain and laboratory indings of elevated levels of serum amylase and serum lipase. In addition to this, due to the movement of the intravascular luid into the abdominal cavity, polycythaemia has been observed in a few such patients, which can potentially predispose to thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), thereby posing a life-threatening risk to the patient. A study was conducted in the Department of General Surgery at Saveetha Medical College and Hospital to assess the incidence of polycythaemia in patients clinically diagnosed with acute pancreatitis by retrospectively analysing the haematology reports of 50 patients. It was found that 5 out of 50 patients (10%) had a inding of polycythaemia in their haematology reports. The identi ication of polycythaemia in pancreatitis patients will help the clinician with the management protocol to prevent the occurrence of thromboembolic events.

INTRODUCTION
Acute pancreatitis is characterised by the in lammation of the pancreas due to reversible parenchymal injury. The most common risk factors precipitating this condition include gallstones and alcoholism. (Lankisch et al., 2002;Venneman et al., 2005) Clinically, acute pancreatitis is diagnosed by its characteristic abdominal pain, along with the laboratory indings of increased serum levels of pancre-atic enzymes and direct visualisation of the in lamed pancreas by CT imaging. The abdominal pain is described as a sudden, stabbing pain in the epigastric region, which may radiate to the upper back. There occurs a marked elevation in the levels of serum amylase, followed by an increasing serum lipase level. (Keim et al., 1998) Polycythaemia refers to a state of elevated packed cell volume and/or haemoglobin concentration. It may either be due to an increase in the number of red blood cells (absolute polycythaemia) or a decrease in plasma volume (relative polycythaemia).
In cases of severe pancreatitis, there may be a loss of intravascular luid into the abdominal cavity (thirdspacing). This decrease in the intravascular luid volume explains the relative polycythaemia, that may be a inding in some of the cases of acute pancreatitis. (Baron and Morgan, 1999) Polycythaemia has been implicated in thromboembolic events such as deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), which could be potentially life-threatening to the patient. This can be avoided by keenly observing the blood investigations for any increase in the red blood cell count, haemoglobin estimation and packed cell volume. In case of values suggestive of polycythaemia, timely intervention can be done to prevent the development of thromboembolic complications.

MATERIALS AND METHODS
This study was conducted in the Department of General Surgery at Saveetha Medical College and Hospital. Data was collected retrospectively regarding patients clinically diagnosed with acute pancreatitis and analysed. The values of serum amylase, serum lipase, RBC count, haemoglobin and packed cell volume were noted for 50 cases of acute pancreatitis from their respective haematology reports.

Inclusion Criteria
Patients clinically diagnosed with acute pancreatitis in Saveetha Medical College and Hospital.

Exclusion Criteria
Patients clinically diagnosed with acute pancreatitis, having other coexisting haematological disorders.

Statistical Analysis
Statistical analysis of the data was done using Microsoft Excel.

RESULTS AND DISCUSSION
Out of the 50 cases of acute pancreatitis that were studied, polycythaemia was observed in 5 patients (10%) [ Figure 1].
In this study, the incidence of polycythaemia, occurring patients diagnosed with acute pancreatitis, was found to be 5 out of the 50 cases studied (10%). A previous study of 4 cases was conducted by (Venkat et al., 2016), regarding the observation of relative polycythaemia in pancreatitis patients, caused by a reduction in the plasma volume due to intravascular volume depletion.

CONCLUSIONS
The study shows that polycythaemia may also be an additional inding to be looked for and taken into account in patients presenting with acute pancreatitis. The identi ication of polycythaemia should help the clinician with the management protocol to prevent thromboembolic events in such patients.