Haem: Polycythaemia Vera: Free MSRA Podcast

🎧 Deep Dive: Polycythaemia Vera (PV)🩸 When the Bone Marrow Doesn’t Know When to Stop...Fatigue, post-shower itching, ruddy complexion — it might not be stress. It could be Polycythaemia Vera, a chronic myeloproliferative neoplasm. In this concise, high-yield episode, we break PV down into bite-sized, exam-friendly chunks perfect for the MSRA.🧠 In This Episode:✅ Definition & Overview• PV = Clonal overproduction of red cells, often with raised platelets and neutrophils• Driven by JAK2 V617F mutation (~95%)• Causes increased blood viscosity and thrombosis risk• It’s a primary polycythaemia (not secondary to hypoxia or EPO)✅ Pathophysiology & Aetiology• JAK2 mutation → constant JAK-STAT activation• Leads to uncontrolled erythropoiesis• Progresses to myelofibrosis or rarely AML✅ Differentials• Relative polycythaemia: dehydration• Secondary polycythaemia: COPD, altitude, tumours• Other MPNs: ET, CML (Philadelphia+)→ 🔑 Tests:– EPO: ↓ in PV– JAK2: present in PV– O2 sats, imaging, red cell mass studies✅ Epidemiology• Rare: ~2/100,000/year (UK)• Affects mostly 60–70 yrs• Slight male predominance✅ Clinical Features• Fatigue, headache, dizziness• Pruritus, esp. after warm baths• Plethora (ruddy face), splenomegaly (75%)• Thrombosis: DVT, PE, MI, stroke• Paradoxical bleeding (platelet dysfunction)• Rarely: Budd-Chiari, erythromelalgia✅ Investigations• FBC: ↑ Hb, Hct, WCC, platelets• JAK2 mutation• ↓ EPO, ↓ ESR, ↑ uric acid• Bone marrow biopsy: hypercellular, trilineage growth• Also: ferritin (low), CXR, abdo US, O2 sats✅ Management🎯 Goal: Prevent thrombosis, delay transformation• Phlebotomy (target Hct < 45%)• Low-dose aspirin• Hydroxyurea or interferon-alpha (cytoreduction)• Ruxolitinib: refractory cases• Treat CV risk: statins, BP control• Symptom relief: antihistamines, SSRIs (off-label)• Gout prophylaxis: allopurinol• Rare: splenectomy for severe splenomegaly🔁 Risk Stratification• Low-risk: phlebotomy + aspirin• High-risk: add cytoreduction (e.g. hydroxyurea)✅ Complications• Thrombosis (stroke, PE, MI)• Myelofibrosis transformation• Rarely: AML (<10%)• Bleeding, gout, splenic infarcts✅ Prognosis• Good with treatment• Median survival: 14–24 years• Younger, fewer clots = better outlook• Lifelong monitoring essential📚 MSRA Revision Resources📝 PV Notes: https://www.passthemsra.com/topic/polycythaemia-revision-notes/🃏 Flashcards: https://www.passthemsra.com/topic/polycythaemia-flashcards/📖 Accordion Q&A: https://www.passthemsra.com/topic/polycythaemia-accordion-qa-notes/🧠 Rapid Quiz: https://www.passthemsra.com/topic/polycythaemia-rapid-quiz/🎯 Practice Quiz: https://www.passthemsra.com/quizzes/polycythaemia/🌐 Explore more:https://www.passthemsra.comhttps://www.freemsra.com💭 Final ThoughtPolycythaemia Vera is a haematology classic — easy to miss, deadly if ignored. Spotting the signs early and tailoring treatment helps prevent life-altering clots. Remember: JAK2 = trigger, Hct = target.#MSRA #PolycythaemiaVera #Haematology #JAK2 #MyeloproliferativeNeoplasm #PassTheMSRA #MSRAFlashcards #MSRAQuiz #PV #ThrombosisPrevention #MSRAAccordions #FreeMSRA #MSRAPodcast #Ruxolitinib #Hydroxyurea