Case Presentation: First-Line Treatment for Low-Risk Polycythemia Vera Case Presentation
Patient Case:
A 48-year-old male patient presented to his primary care physician with a 3-month history of increasingly frequent headaches and a persistent sense of lightheadedness that he initially attributed to work stress. He also complained of pruritic which has been ongoing for several months and which was particularly troublesome with warm showers, which he tried to manage with various topical lotions without relief. He noted that he was very fatigued, and often had to nap after work and on the weekends, which was new for him. He had also noted shortness of breath with physical exertion.
His medical history is significant for hypertension and hyperlipidemia, both of which have been moderately controlled with lisinopril and atorvastatin for several years. On physical examination, the patient had a distinctive ruddy, flushed complexion. Cardiac and pulmonary exams were within normal limits. Palpation of the abdomen reveals a palpable splenic edge on deep inspiration below the left costal margin. Laboratory investigation demonstrated a white blood cell count of 16.6/ul, hemoglobin is 18.9 g/dL with a hematocrit of 58% and platelet count of of 520,000/µL.
The patient was referred to a hematologist for further work-up. A serum erythropoietin reveals a subnormal level. A bone marrow examination was performed which revealed findings consistent with polycythemia vera (PV). A JAK2 V617F mutation was detected with a variant allele fraction of 30%.
The patient expressed concern with regard to both his long term prognosis and current symptoms with polycythemia vera. He wished to pursue a treatment strategy which can reduce his risk of cardiovascular and thrombotic events and reduce his risk of disease progression.
