Physiological Adaptation Q 7
A patient is admitted to the hospital with suspected polycythemia vera. Which of the following symptoms is consistent with the diagnosis? Select all that apply.
A. Weight loss
B. Increased clotting time
C. Hypertension
D. Headaches
E. Tinnitus
Correct Answer: B, C, D & E
Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches, dizziness, tinnitus, and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time.
Option A: Weight loss is not a manifestation of polycythemia vera. Weight loss adversely impacts survival in cancer patients. JAK2 myeloproliferative neoplasms (MPN) upregulate tumor necrosis factor alpha (TNF-?), interleukin-6 (IL-6), and IL-8 and induce decreased leptin levels leading to weight loss. The impact of weight loss in PV patients receiving best supportive care (i.e. frontline hydroxyurea [HU] therapy, phlebotomy) on overall survival (OS) is largely unknown.
Option B: Bleeding and thrombotic complications are each observed in 1% of patients. Bleeding events can include epistaxis, gum bleeding, and gastrointestinal (GI) bleeding. Thrombotic events can include deep venous thrombosis (DVT), pulmonary embolism (PE), Budd-Chiari syndrome, splanchnic vein thrombosis, stroke, and arterial thrombosis.
Option C: The overproduction of red blood cells and high hematocrit levels associated with polycythemia vera can contribute to systemic hypertension; high hematocrit levels have been found to interfere with the vasodilatory effects of nitric oxide. The treatment of polycythemia, which can involve phlebotomy, can alleviate the systemic hypertension, as well as the physiological consequences of having a high red blood cell count.
Option D: As polycythemia vera is a myeloproliferative syndrome, it is based on an autonomic increase in the proliferation of all hematopoietic cells–mostly of erythropoiesis. An increase in blood viscosity induces disturbed microcirculation, resulting in headaches with clinical symptoms.
Option E: Symptoms are related to hyperviscosity and thrombosis, impairing oxygen delivery. Physical complaints can include fatigue, headache, dizziness, tinnitus, vision changes, insomnia, claudication, pruritus, gastritis, and early satiety.