Rapid Review: Polycythemia Vera

Reviewed February 2024

Polycythemia Vera

• Patient presents with headache, dizziness, pruritus after showering
• PE will show hypertension, splenomegaly
• Labs will show increased RBC mass, overproduction of all cell lines, increased Hgb
• Most commonly caused by mutation of the Janus kinase 2 gene (JAK2)
• Treatment is phlebotomy, hydroxyurea, aspirin

Sample Question:

A 57-year-old woman presents to the physician with progressive headaches and dizziness for the past 2 months. During this time, she has also noticed generalized itching when taking a bath. Additionally, she reports recent abdominal pain and a reddish discoloration of her urine. Her temperature is 37.6°C, heart rate is 80 bpm, blood pressure is 148/91 mm Hg, and oxygen saturation of 99% on room air. Her face appears flushed, and the tip of the spleen is palpable 2 cm below the costal margin on abdominal examination. Her hemoglobin concentration is 20 g/dL, hematocrit is 57%, platelets are 300,000/mm3, and erythropoietin levels are above normal. Which of the following is the most appropriate next diagnostic test?