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Heme 1

By Patrick on October 20, 2009 11:22 PM | 3 Comments

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 phlebotomy
B) Therapeutic phlebotomy plus anagrelide
C) Therapeutic phlebotomy plus aspirin
D) Therapeutic phlebotomy plus hydroxyurea
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  • joey: c read more
  • Paul Ramirez: C. This pt has polycythemia vera. The rosy cheeks, splenomegaly, read more
  • Alifeya: Pt has already developed Eissenmenger's physiology, its too late to read more
  • Alifeya: D. read more
  • Paul Ramirez: C. This pt has a ventricular septal defect and eisenmenger's read more
  • mbazylewicz: D. Pulmonary vasodilation will decrease the pulm art. resistance and read more
  • Eric: D. read more
  • Eric: D. read more
  • JuanyGonzalez: D:Pulmonary vasodilation. Left to right shunting, increase volume, leading to read more
  • Alifeya: I will go with D. Pulmonary vasodilator therapy. if I read more