POLYCYTHERMIA VERA

Lai Limson
Golveo
Tabora
Vasquez
Masa Kawaguchi

POLYCYTHEMIA VERA (P VERA)

Is a proliferative disorder of the myeloid stem
cells.
Can last for extended period of 10 years.
Overtime the spleen resumes its embryonic
function of the hematopoiesis and enlarges
Bone marrow may become fibrotic with a
resultant inability to produce as many cells.
Also known as Burnt phase or
Spent Phase.

Clinical Manifestations:

Ruddy Complexion
Splenomegaly
Increase Bp
Increased Uric Acid
Pruritus
Erythromyalgia

Symptoms of the Increase Blood Volume:

Headache
Dizziness
Tinnitus
Fatigue
Paresthesias
Blurred vision

Symptoms of the Increase Blood Viscosity:

Angina
Claudication
Dyspnea
Thrombophlebitis

Assessments and Diagnostic Findings:

Diagnosis is based on
Elevated erythrocyte mass
Normal oxygen saturation level
Enlarged spleen.

Other factors useful in establishing the

diagnosis include elevated leukocyte and
platelet counts.

Assessments and Diagnostic Findings:

Erythropoietin level is not as low as would be
expected with an elevated hematocrit.
Causes of secondary erythrocytosis should not
be present.

Medical Management:
Phlebotomy
The use of chemotherapeutic agents (Hydroxyurea) can
be used to suppress marrow function.
Patients receiving hydroxyurea appear to have a
lower incidence of thrombotic complications than
those treated by phlebotomy which may result in a
normal platelet count.

Anagrelide(Agrylin)
Interferon alfa-2b(Intron-A)
Allopurinol(Zyloprim)
Aspirin

Anagrelide(Agrylin)
Inhibits platelet aggregation and can be useful in
controlling the thrombocytosis associated with
polycythemia vera.
Side effects:
Headache
Fluid retention
Cardiac dysrhythmias
Heart failure

Interferon alfa-2b(Intron-A)
Most effective treatment for managing the
pruritus associated with polycythemia vera.
Side Effects:
Flulike Syndrome
Depression

Allopurinol(Zyloprim)
Is used to prevent gouty attacks in patients with
elevated uric acid concentration.

Aspirin
Is also useful in reducing the pain associated
with erythromyalgia.

Nursing Management
Assessed the risk factors for thrombotic
complications, particularly smoking, obesity,
and poorly controlled hypertension.
Patient should be instructed about signs and
symptoms of thrombosis.
To reduce likelihood of DVT:
Sedentary behaviour, crossing the legs, and
wearing of tight or restrictive clothing
(Particularly stocking) is discouraged.

Nursing Management
Patients with history of significant bleeding are
advised to avoid aspirin and aspirin-containing
medications, because these medications alter
platelet function.
Advised patient to minimised alcohol intake to
further diminished the risk of bleeding.

Nursing Management
Instruct the patient to take iron supplements,
because iron can further stimulate RBC
production.
For Pruritus:
May recommend bathing in tepid or cool water and
avoiding vigorous towelling off after bathing.
Cocoa butter/oatmeal-based lotions and
bath products or baking soda dissolved
in bath water may also be effective.