A 68 year old man with hypertesion treated with HCTZ comes for an annual physical exam.
On examination, temperature is normal, BP is 139/84, HR 87 bpm, and RR 16/min. The patient has rosy cheeks. There is no JVD, cardiopulmonary exam is normal, and spleen tip is palpable just below the left costal margin.
Lab
Hematocrit: 61%Leukocyte count: 11,200/microL
Platelet count: 405,000/microL
Erythropoietin: 10 mU/mL
Arterial oxygen saturation: 96% (on room air)
Cytogenetic studies: positive JAK2 mutation
What is the most appropriate therapy?
A) Therapeutic phlebotomyB) Therapeutic phlebotomy plus anagrelide
C) Therapeutic phlebotomy plus aspirin
D) Therapeutic phlebotomy plus hydroxyurea
D.
C. This pt has polycythemia vera. The rosy cheeks, splenomegaly, elevated Hgb, leukocytosis, moderately high platelets, Low erythropoeitin level, and positive JAK2 mutations are indicators. Initial treatment is phlebotomy to decrease the hematocrit and prevent blood clots. Aspirin is a benign medication that may be prescribed to decrease blood clots as well initially. I believe those two would be most appropriate at this time. Only if the amount of bloodletting is unacceptable should chemotherapeutic agents that inhibit hematopoesis such as hydroxyurea and anagrelide be used.
c