Research Article

Polycythemia Vera: A Case Study and Treatment Exploration

Authors: Elizabeth Warren, Vincent S. Gallicchio

DOI: 10.33425/2771-5906.1030

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Abstract

Polycythemia Vera is a myeloproliferative neoplasm characterized by stark overproduction of erythrocytes despite a lack of physiological signals. Increased erythrocyte levels become risk factors for thrombosis and infarctions, causing the creation of strict treatment plans to keep hematocrit low. Standard treatment plans include phlebotomy as the primary course of action, but various cytoreductive therapies have recently received Food and Drug Administration approval. PV results from a gain of function Janus Kinase 2 (JAK2) mutation, which results in excessive hematopoiesis. While initial symptoms can be mild, and PV can often remain undiagnosed for years, phlebotomy and other hematocrit-reducing agents can introduce negative symptoms that decrease quality of life. Maintenance of a low iron and hematocrit level can introduce symptoms such as bruising, pallor, headaches, dizziness, and chronic fatigue from iron deficiency anemia. Popular cytoreductive treatments include hydroxyurea and ruxolitinib, both proving to be effective treatments for the disorder despite incidences of resistance or intolerance in specific populations. Phlebotomy is also a primary treatment plan, though strict hematocrit maintenance does lead to hyperviscosity in patients, which introduces additional negative symptoms. A case study of a female PV patient analyzed different complete blood count (CBC) and comprehensive metabolic panel (CMP) test levels and found trends in declining erythrocyte levels regardless of the treatment plan. In addition to hematocrit decline, administration of ruxolitinib also presented increased iron levels and decreased platelet levels while maintaining a stable, healthy hematocrit.

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