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Polycythemia Rubra Vera and Artifactual Hypoglycemia

Polycythemia Rubra Vera and Artifactual Hypoglycemia Abstract • A patient with polycythemia rubra vera had had a leukocyte count between 55,000 and 86,000/cu mm and had had serum glucose levels as low as 8 mg/dL. Despite these low serum glucose values, the patient was asymptomatic, and a more careful investigation disclosed that the hypoglycemia was artifactual. This phenomenon, reported in other leukemic states, to our knowledge, has not been previously described in patients with polycythemia rubra vera. Our case broadens the spectrum of the causes of artifactual low serum glucose concentration due to excessive glucose consumption by the WBCs. This phenomenon is related to extreme leukocytosis, regardless of the underlying disease. Unnecessary workup for hypoglycemia can be avoided if its artifactual nature is suspected In any patient with a reported low serum glucose level and high WBC count. (Arch Intern Med 1982;142:2199-2201) References 1. Field JB, Williams HE: Artifactual hypoglycemia associated with leukemia. N Engl J Med 1961;265:946-948.Crossref 2. Hanrahan JB, Sax SM, Cillo A: Factitious hypoglycemia in patients with leukemia. Am J Clin Pathol 1963;40:43-45. 3. Messeloff CR, Stolz C, Schoenfeld MR: Factitious hypoglycemia in chronic myelogenous leukemia. NY State J Med 1964;64:551-552. 4. Salomon J: Spurious hypoglycemia and hyperkalemia in myelomonocytic leukemia. Am J Med Sci 1974;267:359-363.Crossref 5. Goodenow TJ, Malarkey WB: Leukocytosis and artifactual hypoglycemia. JAMA 1977;237:1961-1962.Crossref 6. Gamble WS: Hypoglycemia secondary to chronic myelogenous leukemia. South Med J 1969;62:680-682.Crossref 7. Tolstoi E: Glycolysis in bloods of normal subjects and of diabetic patients. J Biol Chem 1924;60:69-75. 8. Kolmeier KH, Silverstein MN, Fleisher GA: Anaerobic glycolysis in normal and leukemic bone-marrow leukocytes. Cancer 1966;19:1195-1199.Crossref 9. Rawnsley HM, Bowman HM: Autoglycolysis in leukemic and non-leukemic blood. Am J Med Sci 1965;249:203-210.Crossref 10. Falcon-Lesses M: Glycolysis in normal and in leukemic blood. Arch Intern Med 1927;39:412-420.Crossref 11. Macaron CI, Kadri A, Macaron Z: Nucleated red blood cells and artifactual hypoglycemia. Diabetes Care 1981;4:113-115.Crossref 12. Le Blond PF, Weed RI: The peripheral blood in polycythemia vera and myelofibrosis. Clin Haematol 1975;4:353-371. 13. Shenkenberg TD, Waddell CC, Rice L: Erythrocytosis and marked leukocytosis in overlapping myeloproliferative diseases. South Med J 1982;75:868-869.Crossref 14. Jaffe N, Kim BS: Hypoglycemia and hypothermia in terminal leukemia. Pediatrics 1971;48:836-838. 15. Tashima CK, Ruben GC, William T, et al: Symptomatic hypoglycemia in terminal leukemia. JAMA 1968;204:107-108.Crossref 16. Silverstein MN, Wakim KG, Bahn RC, et al: Hypoglycemic factor in leukemic tumors. Proc Soc Exp Biol Med 1960;103:824-826.Crossref 17. Collipp PJ, Kaplan SA, Patrick JR: Reduced liver glucose-6-phosphatase in human leukemia. Proc Soc Exp Biol Med 1965;118:42-43.Crossref 18. Collipp PJ, Patrick JR, Gilchrist GS, et al: Liver glucose-6-phosphatase and carbohydrate metabolism in childhood leukemia. Pediatr Res 1967;1:116-121.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340250165027
Publisher site
See Article on Publisher Site

Abstract

Abstract • A patient with polycythemia rubra vera had had a leukocyte count between 55,000 and 86,000/cu mm and had had serum glucose levels as low as 8 mg/dL. Despite these low serum glucose values, the patient was asymptomatic, and a more careful investigation disclosed that the hypoglycemia was artifactual. This phenomenon, reported in other leukemic states, to our knowledge, has not been previously described in patients with polycythemia rubra vera. Our case broadens the spectrum of the causes of artifactual low serum glucose concentration due to excessive glucose consumption by the WBCs. This phenomenon is related to extreme leukocytosis, regardless of the underlying disease. Unnecessary workup for hypoglycemia can be avoided if its artifactual nature is suspected In any patient with a reported low serum glucose level and high WBC count. (Arch Intern Med 1982;142:2199-2201) References 1. Field JB, Williams HE: Artifactual hypoglycemia associated with leukemia. N Engl J Med 1961;265:946-948.Crossref 2. Hanrahan JB, Sax SM, Cillo A: Factitious hypoglycemia in patients with leukemia. Am J Clin Pathol 1963;40:43-45. 3. Messeloff CR, Stolz C, Schoenfeld MR: Factitious hypoglycemia in chronic myelogenous leukemia. NY State J Med 1964;64:551-552. 4. Salomon J: Spurious hypoglycemia and hyperkalemia in myelomonocytic leukemia. Am J Med Sci 1974;267:359-363.Crossref 5. Goodenow TJ, Malarkey WB: Leukocytosis and artifactual hypoglycemia. JAMA 1977;237:1961-1962.Crossref 6. Gamble WS: Hypoglycemia secondary to chronic myelogenous leukemia. South Med J 1969;62:680-682.Crossref 7. Tolstoi E: Glycolysis in bloods of normal subjects and of diabetic patients. J Biol Chem 1924;60:69-75. 8. Kolmeier KH, Silverstein MN, Fleisher GA: Anaerobic glycolysis in normal and leukemic bone-marrow leukocytes. Cancer 1966;19:1195-1199.Crossref 9. Rawnsley HM, Bowman HM: Autoglycolysis in leukemic and non-leukemic blood. Am J Med Sci 1965;249:203-210.Crossref 10. Falcon-Lesses M: Glycolysis in normal and in leukemic blood. Arch Intern Med 1927;39:412-420.Crossref 11. Macaron CI, Kadri A, Macaron Z: Nucleated red blood cells and artifactual hypoglycemia. Diabetes Care 1981;4:113-115.Crossref 12. Le Blond PF, Weed RI: The peripheral blood in polycythemia vera and myelofibrosis. Clin Haematol 1975;4:353-371. 13. Shenkenberg TD, Waddell CC, Rice L: Erythrocytosis and marked leukocytosis in overlapping myeloproliferative diseases. South Med J 1982;75:868-869.Crossref 14. Jaffe N, Kim BS: Hypoglycemia and hypothermia in terminal leukemia. Pediatrics 1971;48:836-838. 15. Tashima CK, Ruben GC, William T, et al: Symptomatic hypoglycemia in terminal leukemia. JAMA 1968;204:107-108.Crossref 16. Silverstein MN, Wakim KG, Bahn RC, et al: Hypoglycemic factor in leukemic tumors. Proc Soc Exp Biol Med 1960;103:824-826.Crossref 17. Collipp PJ, Kaplan SA, Patrick JR: Reduced liver glucose-6-phosphatase in human leukemia. Proc Soc Exp Biol Med 1965;118:42-43.Crossref 18. Collipp PJ, Patrick JR, Gilchrist GS, et al: Liver glucose-6-phosphatase and carbohydrate metabolism in childhood leukemia. Pediatr Res 1967;1:116-121.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1982

References