A Case of Hydroxyurea Intolerant Polycythemia Vera
A Case of Hydroxyurea Intolerant Polycythemia Vera
June 2016
- A 49-year old male presents with headache, fatigue, and pain under his left ribs
- PMH includes depression and newly diagnosed hypertension
- Physical Exam: BP, 160/90; Abdominal exam reveals splenomegaly spleen palpable 6 cm below costal margin
- Laboratory values:
- Hb=20.7 g/L
- HCT= 59.4%
- WBC=10.2x109/L
- Platelets= 325 x109/L
- Bone marrow biopsy:
- MF-1 fibrosis and megakaryocytic hyperplasia with atypia
- JAK2-positive
- Patient was started on phlebotomy as needed and aspirin 81 mg
October 2016
- Patient returns 4 months later with continued headache and dizziness
- He has had 3 phlebotomies in the past 3 months
- Patient was started on hydroxyurea 1000 mg/day
January 2017
- Patient returns 3 months later with abdominal fullness, continued fatigue, difficulty concentrating, fever, and leg ulcer
- Laboratory values:
- Hb= 22.4 g/L
- HCT= 65.3%
- WBC=13.3x109/L
- Platelets=153x109/L
- Patient is started on ruxolitinib
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