1. Polycythemia vera

2. 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