Dr. Lindquist presented a case of a patient who presented with chronic/progressive abdominal pain who was found to have an H/H of 23/68! (comment below with the highest H/H you’ve ever seen!). He was found to have a splenic vein thrombosis on CT abd & pelvis.

Approach to polycythemia:

After confirming the labs are correct and considering potential secondary causes of polycythemia, initial work up includes getting a JAK2 mutation and EPO level.

Dr. Lindquist created a nice schema for thinking about polycythemia based on presence of HIGH or LOW EPO.


This patient ended up having a positive JAK2 and low EPO level and was diagnosed with Polycythemia Vera. In order to diagnose someone with Polycythemia Vera, you need to meet either all WHO 3 major criteria or 2 major + 1 minor criteria:


Please see this great, new review and update on the treatment of polycythemia vera for more details (Polycythemia Vera and Essential Thrombocytopenia: 2019 update on diagnosis, risk stratification and management. Tefferi and Barbui. AJH 2019) but here is a brief overview of treatment: