Case Overview: A 58-Year-Old Woman With Polycythemia Vera

Prithviraj Bose, MD:We have a 58-year-old woman at The University of Texas MD Anderson Cancer Center presenting with some abdominal pain, dizziness, and headaches; blood pressure is a little elevated, just mildly; a slightly enlarged spleen. She’s never had a clot. Hemoglobin count is elevated at 17.1 g/dL. The white blood cell count is elevated as well, 13.2. The EPO [erythropoietin] level is conspicuously low. Bone marrow shows erythroid hyperplasia, and she has aJAK2mutation.

So here we have a lady who pretty clearly has PV [polycythemia vera]. You see that her hemoglobin count is higher than the WHO [World Health Organization] thresholds. She has a low EPO level. She has aJAK2V617Fmutation. She has a bone marrow that’s typical with the erythroid hyperplasia. She has pancytosis with her white blood cell count being elevated as well, so it’s a pretty clear-cut case of PV.

Transcript edited for clarity.

Case: 58-Year-Old Woman Diagnosed With Polycythemia Vera

November 2018

• A 58-year old woman presents to PCP complaining of abdominal pain, dizziness and headaches
• PE: BP 140/85; Splenomegaly ~6 cm below left costal margin
• PMH: No prior history of thrombosis
• Lab values:
  • HGB: 17.1 g/dL
  • Hct: .50 L/L
  • RBC: 71 x 10¹²/L
  • WBC: 13.2 x 10⁹/L
  • Serum EPO: 4.1 mU/mL
• Bone Marrow Biopsy: Erythroid hyperplasia
• Cytogenetics: JAK-V617Fmutation