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xcretion and that the patients have partially compensated for the hypoxia in another anner.In other cases of polycythemia an inappropriate increase in Ep production is present,since no physiologic hypoxic stimulus can be identified.The increased Ep in these patients appears to arise autonomously and is associated predom-inantly with renal lesions such as cysts,hydronephrosis,adenomas,and car-cinomas,but also with cerebellar hemangioblastomas,hepatomas,uterine leiomyomas,and a variety of tumors and hyperplasias of the endocrine organs.levels are depressed and phlebotomy induces only a modest increase in urinary Ep(102,103).The white cell and platelet counts are often increased,since the disease is not limited to abnormal red cell production.short-term cultures of marrow cells from patients with polycythemia vera indicated that the Ep-stimulated incrEp has been extracted from some of these tumors,and phlebotomy results in no further

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