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Polycythemia 1



Vignette: A 65-year-old man presents to the clinic for a routine check-up. He reports no significant symptoms but mentions that he has been feeling more fatigued than usual. He has a history of hypertension controlled with medication. Physical examination is unremarkable. Laboratory tests show a significant increase in red blood cell count, hemoglobin, and hematocrit. The patient's red blood cell mass is also increased. Which of the following is the most likely diagnosis?


A. Iron deficiency anemia

B. Polycythemia vera

C. Thalassemia

D. Aplastic anemia

E. Sickle cell anemia


B. Polycythemia vera


Polycythemia vera is a myeloproliferative disorder characterized by an increase in red blood cell mass due to overproduction of red blood cells by the bone marrow. This condition can also involve an increase in white blood cells and platelets. This disorder is commonly diagnosed in men over the age of 60. Symptoms include fatigue, pruritus after bathing, and erythromelalgia. The increase in red blood cell count, hemoglobin, and hematocrit seen in this patient, along with his age and symptoms, make polycythemia vera the most likely diagnosis. The other choices are forms of anemia, which would present with a decrease, not an increase, in red blood cell count and hemoglobin.

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