Faheema Hasan: Chronic Methemoglobinemia Causing Longstanding Tissue Hypoxia and Secondary Erythrocytosis
Faheema Hasan, Associate Professor at United Medicity, shared a post on LinkedIn about a recent article by Naseema Gangat et al, published in American Journal of Hematology, adding:
“Hematology is humbling.
Nothing replaces diligent clinical examination
I recently saw a middle aged male patient referred for evaluation of erythrocytosis.
- Hb 21 g/dL
- TLC 8,900/µL
- Platelets 5 lakh/µL
Peripheral smear otherwise unremarkable.
Marked plethora, no organomegaly.
No smoking, no prior treatment.
The textbook work-up for polycythemia followed:
- EPO greater than 100 mIU/mL (elevated)
- JAK2 — negative
Then further investigations pursued
- SPEP — normal
- ECHO — normal
- Low-dose CT (head/neck, thorax, abdomen) — no pathology
The diagnosis remained elusive.
Because his haematocrit was over 60%, I wanted to re-examine him personally. That second look changed everything.
The patient had deeply pigmented skin. His lips appeared unusually dark, and when I asked further, he said they had looked that way ‘for as long as he could remember’.
As a farmer, his nails were discoloured from years of working with soil — masking another clue.
Cyanosis — that classic grey-blue hue we are trained to recognise — was hidden in plain sight.
I sent an arterial blood gas with methemoglobin estimation.
22% Methemoglobin
Normal: < 1–2%
The final diagnosis:
Chronic methemoglobinemia causing longstanding tissue hypoxia and secondary erythrocytosis.
How and how important and indispensible is clinical examination..
And this paper on Jak negative erythrocytosis is exemplary!!
Work up for cause of possible congenital methemohlobinemia is underway.”
Title: JAK2 Unmutated Erythrocytosis: 2026 Update on Diagnosis and Management
Authors: Naseema Gangat, Natasha Szuber, Ayalew Teffer
Stay updated on an scientific advances with Hemostasis Today.
-
Jun 24, 2026, 09:29Advancing Women’s Health Through Collaboration with Jean Hailes for Women’s Health – Stroke Foundation
-
Jun 24, 2026, 09:18The Lasting Immunological Footprint of VITT – JTH
-
Jun 24, 2026, 09:09Umberto Pensato: Dedicated Funding Pathways for Stroke Research in Italy
-
Jun 24, 2026, 09:00Danny Gaskin: BBTS 2026 and the Evolving Role of Transfusion in Maternity Care
-
Jun 24, 2026, 07:46Wolfgang Miesbach: WFH’s First AAV Gene Therapy Chapter Marks a New Era in Hemophilia Care
-
Jun 24, 2026, 06:42Deepthi Krishna: World Blood Donor Day 2026 Celebrations at Rela Hospital
-
Jun 24, 2026, 03:36Ana Pedrero Gil: A New Approach to Post-Tonsillectomy Hemorrhage
-
Jun 24, 2026, 02:59Melissa Hollo: Making Early Anemia Detection the Standard of Care
-
Jun 24, 2026, 02:51Bruno Pougault: The Thin Line Between Bleeding and Clotting