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BOF: 16

A 63-year-old male presents with a history of itching after he has a hot shower. There are no other clinical features of note. He has no significant past illnesses and is not taking any medication.
Which of the following investigations is most likely to lead you to a diagnosis?

a) Alkaline phosphatase levels

b) Blood urea and electrolytes

c) Thyroid stimulating hormone levels

d) The fasting blood glucose levels

e) A Full Blood Count



Answer:

e) 

Aquagenic pruritus is caused by the slow release of histamine when the skin is exposed to water.


The slow rate of release of histamine gives a sufficient concentration to cause itch but is insufficient to cause visible vascular changes.


Aquagenic pruritus is a feature of Polycythaemia Rubra Vera but may also occur in conditions such as Hodgkin's disease and myeloid metaplasia.


Out of the choices given, the full blood count will pick up this haematological condition, which is the most likely cause of this type of pruritus in a male in this age group.


Remember that aquagenic pruritus may precede the development of Polycythaemia Rubra Vera by several years.

 

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