I.

Objective

This case analysis aims for the easy remedies that the patient could to minimize or
totally eradicate the signs, symptoms and the factors that could trigger the illness to occur
or re-occur.

II. Introduction

The word "polycythemia" is composed of the Greek words "poly" (many), "cyt"
(cells), and "hemia" (blood). Thus, it is applied to a disease in which there are too many
of the principal cells (red, white, and platelets) in the blood. The term "vera" is from the
Latin word meaning true. The latter term is used to distinguish this disorder from a host
of other conditions that can result in an increase in the number of red cells in the blood.
Polycythemia vera, often abbreviated as PV, is a disease that results from an
abnormality of a very immature cell in the bone marrow, the site in which all blood cells
are made. The altered cell develops a growth advantage and produces blood cells in such
large numbers that they are overrepresented in the marrow. There is some variation in
this abnormality. In virtually all cases of polycythemia vera, the marrow produces too
many red blood cells. In many patients, the numbers of white blood cells and blood
platelets are also elevated.
The increase in red cells and a reciprocal decrease in plasma can lead to blood that is
thicker than normal (viscous) and does not flow normally.

III. A. Patient's Profile

Name:
Age:
Birthday:
Address:
Highest Educational Completed:
Religion:
Occupation:

B. Patient's Health History

Client is a storekeeper and mostly spends her time staying in their house.
She said that she is fond of eating salty and fatty foods and the mere fact that she is not
having exercises at all, she just sits throughout the day.
Client was recently diagnosed with polycythemia vera. The doctor has explained to
her what is her condition, she has a high level of cholesterol and blood making viscous
and thick (which may eventually lead to HPN). Plus she said, her doctor also said that she
has an anemia. Though she doesn’t experience any sign and symptoms yet, this disease is
really a high risk which needs prompt interventions.

C. Physical Assessment
 • Enlarged spleen
• Enlarged liver
• Skin redness:
o Mainly in the face and extremities
• Bone tenderness
Tests are necessary to make the diagnosis of polycythemia vera.

IV. A. Causes

Polycythemia vera is a disorder of the bone marrow. It causes too much production
of white blood cells, red blood cells, and platelets.
It is a rare disease that occurs more often in men than women, and is rare in patients
under age 40. The exact cause is unknown.

B. Signs and Symptoms

• Breathing difficulty when lying down
• Dizziness
• Fullness in the left upper abdomen
• Headache
• Itchiness, especially after a warm bath
• Red coloring, especially of the face
• Shortness of breath
• Symptoms of phlebitis
Note: Symptoms are due to increased blood thickness and clotting.

Other symptoms that may occur with this disease:

• Bluish skin discoloration
• Fatigue
• Red skin spots
• Vision problems

C. Possible complications
• Bleeding from the stomach or other parts of the intestinal tract
• Gout
• Heart failure
• Leukemia
• Myelofibrosis
• Peptic ulcer disease
• Thrombosis (blood clotting, which can cause stroke or heart attack)

V. Anatomy and Physiology

Blood is a circulating tissue that carries nourishment and oxygen to the cells and
tissue. Blood is composed of 3 cell types that are suspended in a protein-rich fluid called
plasma:
• Red blood cells (erythrocytes)
• White blood cells (leukocytes)
• Platelets (thrombocytes)

Red Blood Cells

Red blood cells contain hemoglobin, which is the molecule that carries oxygen to
the tissues. A decrease in the number of red blood cells reduces the amount of oxygen
that can be carried by the bloodstream. This can result in poor exercise tolerance and
fatigue.

Normal ranges for the total number of red blood cells in adults are:
• 4.6-6.2 million per cubic millimeter (males)
• 4.2-5.4 million per cubic millimeter (females)

White Blood Cells

White blood cells are an important part of the immune system. There are several
types of white cells (leukocytes) present in the blood. These cells mainly function to fight
infection. Normal total ranges for white blood cells are: 4,500 - 11,000 (per cubic
millimeter). Slightly higher counts are normal in children.

A white blood cell differential reports the percentages of the different types of white
blood cells that comprise the total white blood cell count. These values are reported as a
percentage of the total number of cells.

Cell Type % Of Total Elevated In

WBC's
Neutrophils 47% to 77% infection, inflammation
Bands 0% to 3% bacterial infection
Lymphocytes 16% to 43% viral infection, leukemia
Monocytes 0.5% to 10% infections, cancer
Basophils 0.3% to 2% leukemia, cancer, hypothyroidism
Eosinophils 0.3% to 7% allergies, leukemia, lymphoma

Platelets

Platelets are the smallest of the blood cells. They play an essential role in the blood
clotting system. A platelet count: 150,000-400,000 per cubic millimeter is considered a
normal range.

VI. Pathophysiology
 Rbc, wbc, platelets Hemorrhage
mboembolism Rupture
Blood viscosity Capillary overdistention

Organ infiltration

Hepatomegaly Splenomegaly Arthralgia Cerebral hypoxia

VII. Nursing management

• Increase fluid intake to reduce blood viscosity.

• Monitor for signs and symptoms of bleeding.
• Monitor for signs and symptoms of thromboembolism:
o Angina
o Claudication
o Thrombophlebitis
o Pruritus
• Administer analgesic as ordered.
• Administer antihistamine to decrease pruritus.
• Patient teaching: Avoid high altitude (mountains, airplane travel). Low oxygen
levels in high altitudes tend to stimulate the kidneys to increase secretion of
erythropoietin. This causes increased rbc production.

VIII. Medical management

The goal of treatment is to reduce the thickness of the blood and prevent bleeding
and clotting.
• Phlebotomy for polycythemia vera:
o Removes excess blood cells from the bloodstream
• Medications for polycythemia vera:
o Aspirin therapy for polycythemia vera
o Hydroxyurea (Droxia, Hydrea)
o Anagrelide (Agrylin)
 o Alfa-2a (Roferon-A)
o Alfa-2b (Intron A)
• Oral antihistamines for itching:
o Diphenhydramine (Benadryl)
• Chemotherapy to inhibit hyperactivity of the bone marrow.
• Radiation therapy (Na Phospate/ IV)
• Splenectomy for polycythemia vera:
o Removal of the spleen
• Polycythemia vera clinical trials
• Keep scheduled appointments with your doctor.

IX. Recommendation

A. For the patient

• Educate yourself.
• Be skeptical: Learn to separate fact from fiction.
• Billions of dollars are spent each year marketing dietary supplements, vitamins,
and new medical treatments. Much of this is unnecessary and wasteful.
• Be careful about where you get your health information.
o Some of the best sources for health information on the web are
professional societies and non-profit organizations.
o Ask your doctor what he or she recommends.
• Examine the credentials of the authors.
o If you are reading about symptoms and disease, your best source is a
licensed physician.
o Pay attention to when the content was last updated.
o Make sure the person is not just trying to sell you something.
• Important questions you need to answer:
o What things in your control can increase your risk for disease?
o What can you do to decrease this risk?
o What are vaccines and how can they help you?
o How do your lifestyle choices increase your risk for disease?
o How can you reduce stress?
o What minor health problems can you treat at home?
o When is a medical problem "serious"?
o When should you call the doctor?