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