Uncontrolled Polycythemia Vera: Case 1

May 8, 2017

Uncontrolled Polycythemia Vera


August 2014

  • A 67-year-old female is diagnosed PV after complaining of fatigue
  • Physical Exam was unremarkable
  • CBC:
    • HCT, 48%
    • WBC, 12,100/μL
    • Platelets, 603,000/μL
  • Mutation testing: JAK2 V617F-positive
  • The patient was started on treatment with low-dose aspirin and hydroxyurea 500 mg/day
  • Her symptoms resolved within 3 months

February 2016

  • She now complains of left upper quadrant pain
  • For 1.5 years, the patient was maintained on treatment; however, for the past 9 months her hematocrit has risen to 48% and she has required 4 phlebotomies in last 6 months
  • Hydroxyurea was increased from 500 mg to 1,000 mg daily
  • Physical Exam: remarkable for splenomegaly

August 2016

  • Physical Exam: still remarkable for splenomegaly, slightly smaller
  • HCT 47.5%