Polycythemia vera

Patient’s salient features Polycythemia vera Initial presentation Obliterated Traube’s space Massive splenomegaly Associated signs and symptoms Neurologic Headache dizziness Vertigo Tinnitus Visual disturbances Circulatory BP of 190/110 Known hypertensive for 2 years Systolic hypertension Hematologic High hemoglobin – 190g/L High hematocrit – 0.60 plethora High hemoglobin High hematocrit Digital ischemia Easy bruisability Epistaxis GI hemorrhage Incidental findings and complications Pruritus after showering Occassional claudication Neurologic complications: (+) slurring of speech (+) shallow left nasolabial fold (+) tongue deviation to the right upon protrusion MMT: 2/5 on both left upper and lower extremities Weight loss of 25% in the past 3 months Aquagenic pruritus Venous or arterial thrombosis involving vital organs; liver, heart, brain, lungs Hyperuricemia Uric acid stones Erythromelalgia: erythema, warmth, pain, and occasionally digital infarction involving the lower extremities