Do the blood work reports and enlarged spleen look like I have polycythemia vera?

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I understand your concern.

I have reviewed your reports (attachment removed to protect the patient's identity).

Your hemoglobin and hematocrit are borderline high, and liver enzymes are deranged, the blood glucose level is relatively high, the spleen is slightly enlarged. In a setting of infectious diseases such as COVID-19, dehydration is common, take 1.05 gallons of water every day and repeat CBC (complete blood count) test after a week. Mild splenomegaly is commonly encountered in viral infections and liver diseases such as drug-induced, viral, or NAFLD (non-alcoholic fatty liver disease) associated liver injuries.

Get an echocardiography test because heart muscle weakness is common in diabetes mellitus. It also increases hemoglobin due to inadequate pumping of oxygen-saturated blood for the body.

A negative JAK2 mutation test does not preclude polycythemia vera.

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Hi,

Welcome back to icliniq.com.

I understand your concern.

1) Hemoglobin levels do not reduce in polycythemia vera instantly, without any treatment.

2) Aspirin is a blood thinner. It does not affect hemoglobin directly. Instead, it reduces platelet function and keeps them from aggregating and clotting inside blood vessels. It is used in high hemoglobin states (which promotes intravascular clotting due to sluggish blood flow) to reduce blood clotting.

3) Keep yourself hydrated with around 1.05 gallons of liquids, especially water, for a few weeks.

Your hemoglobin is currently on the borderline but not of clinical significance.

Get an abdominal ultrasound report done for a fresh reassessment of your spleen. Your liver enzymes, blood glucose, and other parameters are well in range. That seemed to be a temporary disease-related effect. Elevated hemoglobin is seen in smokers, those living at high altitudes, congestive cardiac failure, chronic obstructive pulmonary disease, and in some erythropoietin-secreting kidney adenomas it is rarely seen. It could be a part of primary polycythemia. Rule out the causes of secondary polycythemia. If all causes are excluded, get tested for JAK2, Exon12, and CALR mutations. Even in primary polycythemia, also called polycythemia rubra vera, these mutations are frequently negative. In cases of secondary polycythemia, the treatment of elevated hemoglobin is to treat the cause. In primary polycythemia, if JAK2 is negative, the treatment is therapeutic phlebotomy or venesection.

The goal is to keep hemoglobin and hematocrit within a range for males with less than 50 L/Lhematocrits and females with less than 48 L/L. And hemoglobin in males is 16 g/dL, and in females up to 15 g/dL. It can be combined with hydroxyurea and calculated according to the patient's weight. Repeated venesections or phlebotomies can lead to micronutrient deficiency, especially iron. Therefore, the patient should be given micronutrient replacement therapy. For JAK2-positive patients, Ruxolitinib tablets are given 5 to 15 mg daily. Another option is IFN alpha (Pegasys) in low doses (45 ug for one week) in both JAK2 positive and negative cases. CALR positive cases show superior results on this mode. However, it could take years to cure the disease. Meanwhile, along with all therapeutic modalities, thrombophilia prophylaxis is given. This is not a life-threatening disease. The patient can die with this but does not die because of it.