ASSESSMENT AND DIAGNOSTIC FINDINGS

Physical Examination (is important)

 Looked plethoric (ruddy, red color of the face, hands, feet, ears, and mucous
membranes)
(Since he is producing too much red blood cells in his body.)

 Discomfort felt in the upper left side of abdomen upon palpation

(It was found out that there has been an enlargement of his spleen, so our
patient is suffering from splenomegaly. The increased number of blood
cells caused by polycythemia vera makes your spleen work harder than
normal, which causes it to enlarge.)

 Complained of pain in his left leg specifically the calf during dorsiflexion
(Positive Homan’s sign was also a sign and symptom of our patient.
Positive Homan’s sign is an indicator of DVT. In polycythemia, an
increased risk of thrombosis has been attributed to hyperviscosity due to
increased red blood cell production and poor blood flow state.)

Vital Signs

 PR = 67 bpm
 RR = 18 cpm
 BP = 150/90 mmHg
 SaO2 = 97%

Lab Values

(So we learned in the pathophysiology, that polycythemia vera leads to a

constantly increasing production of red blood cells. That’s why the
hemoglobin, hematocrit, and red blood cell count of this patient are above
normal limits.)

 HGB = 21 g/dL (grams per deciliter)

 HCT = 60%
 RBC = 7.74 M/cumm (millions per cubic millimeter)

 Basophil = 1.3%
(In polycythemia vera, a marked increase in the number of basophils can
occur. These basophils release histamine which is causing the itching
experienced by our patient.)
  WBC = 11.7 T/cumm (thousands per cubic millimeter)
 PLT = 465 T/cumm (thousands per cubic millimeter)
(The production of white blood cells and platelets are elevated in
polycythemia vera. High platelet count can contribute to the formation of
clots. The clots may cause serious problems, such as deep vein
thrombosis, heart attack, or pulmonary embolism.)

 EPO = 2.2 mU/mL (milli units per milli liter)

(In primary polycythemia, EPO levels are usually low to low-normal. High
blood levels of RBC, hemoglobin, hematocrit, or oxygen suppress the
release of EPO. Increased erythrocytes result in compensatory
suppression of EPO levels.)

 JAK2 V617F: positive

(Our patient is positive of the JAK2 V617F mutation. In polycythemia vera,
the Janus-kinase 2 gene causes uncontrolled blood cell production.)

***ruxolitinib (Jakafi) (only FDA-approved drug that works with JAK2 enzymes)
- regulates the production of blood cells. It does this by slowing the function of
JAK2 in hematopoietic stem cells.

 ABG Values:
 pH = 7.35
 PaO2 = 92 mmHg
 PaCO2 = 35 mmHg

(ABG values of our patient are within normal limits and showed no
signs of hypoxia.)

Blood Tests

1) Complete Blood Count

(If a person has polycythemia vera, his doctor will first do a test called a
complete blood count. A CBC will measure the number of red blood cells,
number of WBC, platelets, as well as the hemoglobin and hematocrit levels,
and some other factors in your blood.)

 Elevated hemoglobin and hematocrit count

 Elevated red blood cell, white blood cell, and platelet count
 2) Erythropoietin Test

(This quick blood test looks for erythropoietin, a hormone that tells your
bone marrow to make new blood cells.)

 Low levels of EPO

Genetic Tests (Gene Test is important)

 Tested positive for JAK2 gene mutation

(Since his CBC results are abnormal, the doctor will use genetic tests to
look for the JAK2 mutation associated with the disease.)

Bone Marrow Tests

(Bone marrow tests show whether your bone marrow is healthy. This will
determine if your bone marrow is making too many blood cells. The doctor will
determine whether a bone marrow biopsy maybe necessary to confirm the
diagnosis.)

 High blood cell count (RBC, WBC, and PLT)

What is polycythemia vera?

Polycythemia vera (PV) is a rare type of blood cancer in which your body produces too
many red blood cells. Red blood cells carry oxygen throughout your body.

When you have too many red blood cells, your blood thickens and flows more slowly.
The red blood cells can clump together and form clots inside your blood vessels.

Blood that flows more slowly can reduce the amount of oxygen that reaches your heart,
brain, and other vital organs. And blood clots can completely block blood flow within a
blood vessel, causing a stroke or even death. Long term, PV can lead to scarring of the
bone marrow as well as leukemia, another type of blood cancer.
Blood carries oxygen to all parts of the body. Polycythemia vera slows blood flow, which
makes it hard for oxygen to reach your organs.

Arterial Blood Gas

An arterial blood gas (ABG) test is a blood test. It measures your blood’s oxygen level.

To get an ABG measurement, your doctor will draw blood from an artery rather than a
vein. (Blood drawn from arteries is oxygenated.)