Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

Polycythemia Vera - Part 2

Tom Deloughery, MD and Matthieu DeClerck, MD
00:00
10:34
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Polycythemia vera is a relatively rare myeloproliferative disorder characterized by increased RBC production. In this segment, our own Matt DeClerck interviews Hematology guru Dr. Tom Deloughery on the in’s and out’s of PV. Clinical suspicion for PV should occur in any patient with elevated RBC mass, elevated Hgb/Hct, aquagenic pruritus, erythromelalgia, and/or systemic thrombi (MI, stroke, DVT, etc). Diagnosis is confirmed by presence of the JAK2 gene mutation. Treatment is focused on decreasing RBCs with phlebotomy and/or cytoreductive therapy; symptom control; and treatment/prevention of arterial or venous thrombi.

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Danni E. -

Just saw a patient in clinic last week. Likely secondary polycythemia related to tobacco use and living at altitude. Is it necessary to order the jak2 mutation on all patients with suspected polycythemia, or is it reasonable not to order that in patients who don't have obvious secondary causes? Thank you very much. I really appreciate your podcast.

Danni E. -

We ended up only repeating the CBC and ordering phlebotomy which she has had one of already. Her HCT was around 60. Younger patient, age 40.

Neda F., MD -

Hi Danni. Thanks for your patience. Here is Dr. DeLoughery's response: "This is a very common clinical issue. I do cut people slack for smoking and altitude but 60% in a women is very high and I would work-up. Unless there are other symptoms I do think carefully before ordering expensive tests in men if the Hct < 55% or women if less than 50% - this is based on Mayo Clinic data (Eur J Haem 12:285, 2000). The rule of thumb I use about smoking is a pack a day adds ~ 1-2 hct % and 1500 meters of altitude add about ~1-2% and for 2000M maybe up to 3%."

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
This Mailbag is About to Rupture! Full episode audio for MD edition 191:34 min - 90 MB - M4APrimary Care RAP - May 2019 Written Summary 601 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education or 0.25 Free prescribed credits by the American Academy of Family Physicians

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education or 3.25 prescribed credits by the American Academy of Family Physicians

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate