How I Treat How I treat polycythemia vera

I will take advantage of the history of two gentlemen that I encountered in the office some years apart to illustrate how I manage subjects referred for the investigation of erythrocytosis and are then found to have polycythemia vera (PV) rather than relative or secondary erythrocytosis (Table 1). Therefore, this manuscript is not intended to provide a thorough description of the disease or to address still debated topics, but rather to focus on daily practical aspects. Case 1 was a 47-year-old dentist who presented in early 2012 with a routine blood test showing the following: hemoglobin (Hb), 233 g/L; hematocrit (Hct), 68.9%; mean corpuscular volume, 81 fL; leukocytes, 4.4 3 10/L; platelets, 145 3 10/L; hyperuricemia, and subnormal ferritin levels. He said he felt “perfectly well,” “I am working 10 hours a day,” but during the interview, he acknowledged to have occasional scotoma and tinnitus in the last weeks; a physical examination was unremarkable except for mild hypertension. I ordered additional blood tests and prescribed aspirin; phlebotomies were initiated the same day. Case 2 was a 68-year-old retired man, who was a heavy smoker, seen in 2003, in which we discovered the following abnormalities: Hb, 178g/L;Hct, 57.7%;meancorpuscular volume, 74 fL; leukocytes, 13.63 10/L; platelets, 5353 10/L. One year before, he had an acute myocardial infarction; an Hb and Hct of 165 g/L and 52.6%, respectively, were not further investigated. He was on antihypertensive medications and antidiabetics andwas taking aspirin. He complained of tiredness, itching, and paresthesia. The spleen was palpable at 5 cm from the left costal margin (LCM). A diagnostic path was initiated, and phlebotomies were prescribed.