Some patients who undergo renal transplantation will afterwards develop an erythrocytosis secondary to an increase in the red blood cell mass. This places the patient at increased risk for a thrombotic episode.


Risk factors associated with post-transplant erythrocytosis:

(1) male gender

(2) normal to high serum erythropoietin levels prior to the transplantation

(3) history of smoking

(4) renal artery stenosis in the transplant kidney

(5) acute or chronic rejection

(6) hydronephrosis


The erythrocytosis may be transient or it may be persistent if untreated.


Therapy that may reverse the erythrocytosis:

(1) therapy with an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker

(2) removal of the native kidneys (if retained)

(3) limiting iron supplementation (Kessler et al)


Differential diagnosis:

(1) increase in RBC due to a decrease in plasma volume


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