Websites on raised haematocrit

Dr Keith Barnard recommends websites relating to this week’s Clinical Review

Website of the week

Make no mistake, this website is not chosen as website of the week because I think it is particularly meritorious, but because it offers a cautionary tale. This herbal medicine website looks good – it is not covered in the garish red block-lettered testimonials that shout at the reader with outrageous claims.

This reserved approach if anything makes me even more uneasy, because the page starts with a detailed clinical description of polycythaemia that appears authoritative, and so more likely to tempt a patient to opt for this treatment for their potentially fatal myeloproliferative disorder rather than conventional therapy. The patient is asked to fill in an enormously long questionnaire and also to select the photograph of a tongue that has the appearance closest to their own. This apparently enables the purveyors of this remedy to prepare a custom-made combination of herbs. This, it is claimed, will be long enough for the remedy to have an effect on their polycythaemia ‘recommended for most individuals with different responses’ – whatever that means. And all this for a mere £200.

Why go there: increase our awareness of what is offered to our patients.
Downside:
may encourage patients to neglect more effective treatment.
Information from: Herb China 2000 Inc.
Address: www.herbchina2000.com/therapies/HPT.shtml

Details of the haematocrit
One of the enjoyable things about searching for websites for this column is that every now and then you come across a valuable resource that you did not know existed. Lab Test online is one of these. It is billed as a public resource on clinical lab testing from the laboratory professionals who do the testing.

The site is the product of a collaboration of professional societies representing the lab community, and it is aimed at patients rather than GPs. This does not detract from its value, however, as the description of the haematocrit, why it is requested and how it is used contains enough information for anyone who needs to be reminded about the details.

I believe lab technicians are unsung heroes who get little recognition or recompense for their contribution to healthcare, and this is a welcome opportunity to put them in the spotlight.

Why go there: useful reminder
Downside: none.
Information from: Lab Test Online.
Address: www.labtestsonline.org.uk/understanding/analytes/hematocrit/test.html

Diagnosis and management of polycythaemia
I think it will be hard to find a more straightforward account of this condition in such an assimilable form as this six-page PDF. This paper about the diagnosis and management of polycythaemia was published online only last year by a reputable journal, so is authoritative and bang up-to-date. The evaluation of erythrocytosis given here is interesting, and we are reminded that not all raised haematocrit values are due to polycythaemia rubra vera, but may have relative, primary or secondary causes.

Most space is devoted to rubra vera, however, and the criteria for diagnosis are given in some detail. The discussion about specific problems such as increasing splenomegaly, pruritis, elective surgery and pregnancy are particularly useful. 

Why go there: covers the field well.
Downside: illustrations would help.
Information from: Journal of the Royal College of Physicians of Edinburgh.
Address: www.rcpe.ac.uk/publications/articles/journal_37_1/N-kumar.pdf

Information for patients
For some reason I have not previously come across the excellent patient information resource offered by this NHS sponsored website. I was impressed generally by the DoctorOnline site, it is well laid out, pleasant to read, and easy to navigate. There is a prodigious array of patient leaflets here, and this one on polycythaemia rubra vera is commendably brief for what is a complex topic.

I liked the positive way it approaches what can be a debilitating and fatal condition. Some websites strive for too much ‘telling it like it is’ and don’t consider the fact that patients often access this information on their own and cannot discuss the broader picture with anyone.

Why go there: sensible advice, well presented.
Downside:  a formatted PDF to print would be an improvement.
Information from: DoctorOnline.
Address: Please click here

Dr Barnard is a former GP in Fareham, Hampshire

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