Polycythemia, Primary

Black toe

Step 1: View clinicals

A 58 year old man presents with pain and blackish discoloration of his right little toe for 1 week, in a background of exertional dyspnea, fatiguability and intermittent headaches for 4 months. No other symptoms are present. He has no known medical conditions and has never smoked. At a recent checkup, a fasting blood sugar, lipid profile, liver and renal profile, ECG, chest x-ray and echocardiogram were found to be normal.


Step 2: Order all relevant investigations

Full Blood Count

WBC: 14,500/mm3 (N:73%) Hb: 18.5 g/dl Hct: 60% Platelet: 846,000/mm3 Blood film: Normocytic-normochromic erythrocytosis, neutrophilia with a left shift and thrombocytosis with normal morphology. No abnormal cells.

Ultrasound Abdomen

The ultrasound scan of the abdomen shows minimal splenomegaly. No other abnormalities are present.

Bone marrow biopsy

The bone marrow biopsy shows a hypercellular marrow with prominent erythroid, granulocytic and megakaryocytic proliferation. No abnormal cells are seen.

Erythropoietin level

The serum erythropoietin level is 2.3 mU/ml (normal range: 4.3 to 32.9)


Step 3: Select appropriate management

Anti-platelet therapy
Antibiotics
Phlebotomy
Steroids


Score: ★★☆