We discussed a case of a young man w/ HTN, HLD, hx PE s/p anticoagulation, tobacco use disorder, and significant family cardiac history, who presented for acute on chronic chest pain, and was found to have multivessel CAD and polycythemia.

Framework for polycythemia

  • Relative (hemoconcentration)
  • Absolute
    • Primary / polycythemia vera (PV)
    • Secondary
      • Hypoxia, tumor-associated (EPO secretion), Misc (blood doping, exogenous EPO, androgen/steroids)

Clinical manifestations of PV

  • Aquagenic pruritus
  • Erythromelalgia
  • Facial plethora
  • Thrombosis (CVA, MI, DVT, PE)

Treatment of PV

  • Therapeutic phlebotomy: goal Hct < 45%
  • Low-dose ASA
  • Cytoreduction (hydroxyurea) for high risk PV

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