The myomatous erythrocytosis syndrome: A review

To review the literature regarding the association of erythrocytosis and uterine myomas, because of the lack of anemia in many women with menorrhagia and fibroids. We searched the MEDLINE Englishlanguage data base and reference lists to find articles referring to the myomatous erythrocytosis syndrome. All case reports of the myomatous erythrocytosis syndrome were included in this review. Symptoms, laboratory studies, histopathologic findings, and possible etiologies for each of 31 cases were extracted. The symptoms described were most commonly related to the presence of a myomatous uterus with occasional manifestations of erythrocytosis. A routine complete blood count was used to diagnose erythrocytosis in all cases. Evaluation of the bone marrow, blood volume, erythrocyte life span, and erythropoietin activity have all been used to help confirm the diagnosis. The histopathologic findings were similar to those commonly seen in myomas. Possible factors in the etiology of this syndrome include: vascular shunts within the myoma, large uterine size, myoma site, change in red cell life span, alteration in erythropoietin production by the kidney, and autonomous secretion of erythropoietin or an erythropoietin-like substrate by the myomatous uterus. Elevated levels of erythropoietin accompany the myomatous erythrocytosis syndrome. All myomas may alter erythropoietin production, causing varying degrees of erythrocytosis, which could explain the lack of anticipated anemia despite the presence of menorrhagia. Use of the currently available, highly sensitive radioimmunoassay for erythropoietin should help in our understanding of the role uterine myomas play in erythropoiesis.