Which physical findings are characteristic of polycythemia vera (PV)?

Updated: Sep 20, 2021
  • Author: Srikanth Nagalla, MD, MS, FACP; Chief Editor: Sara J Grethlein, MD, FACP  more...
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Physical findings in patients with polycythemia vera (PV) are due to the myeloproliferative process and excess concentrations of the cellular elements of blood with extramedullary hematopoiesis. Splenomegaly is present in 75% of patients at the time of diagnosis. Hepatomegaly is present in approximately 30% of patients.

Plethora or a ruddy complexion is characteristic of PV and results from the marked increase in total red blood cell mass. This manifests in the face, palms, nailbeds, mucosa, and conjunctiva.

Hypertension is common in patients with PV. Measurement of the red blood cell mass should differentiate this condition from Gaisbock syndrome, which is hypertension and pseudopolycythemia (ie, high hemoglobin levels due to low plasma volume).

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