title: Bumpy road to the diagnosis of polycythaemia vera.
abstract: Polycythaemia vera (PV) is the most common myeloproliferative neoplasm, characterised by increased red cell mass that can present as an unspecified symptom or a thrombohaemorrhagic event. Its diagnosis is based on the presence of erythrocytosis, the identification of the Janus kinase 2 mutation and bone marrow aspirate or biopsy alterations. The challenge of this disease lies on the treatment approach. Its cornerstone is phlebotomy, but depending on the vascular risk, it can include cytoreductive agents, low-dose aspirin or even anticoagulation. We present the case of a 75-year-old woman, whose inaugural presentation of PV was an arterial peripheral occlusion followed by three recurrent events in the same arterial region and a pulmonary embolism. A phlebotomy was initially performed and, after the diagnosis was made, the patient was initiated on low-dose aspirin and anticoagulation with favourable outcome.
authors.affiliation: Medicina Interna, Hospital Beatriz Ângelo, Loures, Portugal.
authors.forename: Rita de Sousa
authors.initials: RS
authors.lastname: Gameiro
authors.affiliation: Medicina Interna, Hospital Beatriz Ângelo, Loures, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Medicina Interna, Hospital Beatriz Ângelo, Loures, Portugal.
authors.forename: Fernando Martos
authors.initials: FM
authors.lastname: Gonçalves
authors.affiliation: Medicina Interna, Hospital Beatriz Ângelo, Loures, Portugal.
authors.forename: José Pimenta da
authors.initials: JP
authors.lastname: Graça
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018962:Phlebotomy; D011087:Polycythemia Vera / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011655:Pulmonary Embolism / Q000175:diagnosis*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D001241:Aspirin