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Myeloproliferative Neoplasms Case Studies

Case Studies: Hydroxyurea Resistant Polycythemia Vera

In this case-based interview, Ruben A. Mesa, MD, discusses the case of a young male patient with polycythemia vera not adequately controlled on phlebotomy and hydroxyurea.

Hydroxyurea Resistant Polycythemia Vera

January 2015

  • A 39-year-old male presents with headache and weight loss
  • He is a 2-pack a day smoker
  • PMH includes type 2 diabetes, moderately controlled on medication; newly-diagnosed hypertension
  • Physical exam: BP, 176/94, otherwise unremarkable
  • Laboratory values:
    • Hb; 233 g/L
    • Hct; 68.9%;
    • Mean corpusc. vol.; 81 fL
    • Leukocytes; 4.4 × 109/L
    • Platelets; 145 × 109/L
  • Bone marrow biopsy;
    • MF-3 fibrosis and megakaryocytic hyperplasia with atypia
    • Normal karyotype
    • JAK2-positive
  • Patient was started on phlebotomy as needed and aspirin

April 2015

  • Patient had 3 phlebotomies in the last 3 months.
  • He reported increasing dizziness, headaches and nausea
  • He was continued on phlebotomy as needed; aspirin was continued
  • Patient was started on Hydroxyurea 1000 mg daily

July 2015

  • Patient comes back 3 months later, he has had 2 phlebotomies
  • Hydroxyurea is increased to 1500 mg

October 2015

  • Patient returns 3 months later with pruritus, still requiring phlebotomy
  • He is started on hydroxyurea 2000 mg daily

January 2016

  • The patient has had 2 phlebotomies since his last visit; he reports abdominal fullness
  • He also has restless legs and is complaining that food tastes funny
  • Spleen is palpable 7 cm below costal margin

 

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