Saagar Pamulapati¹, Ajay Doniparthi², Suneha Pocha¹*, JR Bales³, Morgan Lain³, Mahmoud Al-Fadhl³, Sneha Pamulapati⁴, Mark Walsh⁵ and Vibhav Bansal⁶

¹Internal Medicine, Mercyhealth Javon Bea Hospital, United States ²Medical Student Education, University of South Florida Morsani College of Medicine, Tampa, Florida, United States ³Medical Student Education, Indiana University School of Medicine - South Bend Campus, Notre Dame, Indiana, United States ⁴Medical Student Education, Midwestern University, Downers Grove, Illinois, United States ⁵Emergency Medicine, Saint Joseph Health System, Mishawaka, Indiana, United States ⁶Neurology, Mercyhealth Javon Bea Hospital, United States

*Corresponding Author: Suneha Pocha, Internal Medicine, Mercyhealth Javon Bea Hospital, United States.

Received: September 30, 2023; Published: November 03, 2023

Abstract

Polycythemia vera is a rare, BCR-ABL negative, myeloproliferative neoplasm predominantly characterized by increased erythrocytes and elevated hematocrit. Although predominantly asymptomatic, potential symptoms may include headache, dizziness, and claudication as a result of a hyper viscous and hypercoagulable state. Despite the well-known risk between PV and thrombotic events, research describing this relationship and its treatment remains underreported. In this paper, we describe a PV patient with an acute presentation of cerebral ischemic stroke treated with phlebotomy and normal saline intravenous administration.

Keywords: Polycythemia Vera; Ischemic Stroke; Fluid Resuscitation; Phlebotomy; Thrombotic Complications in PV

References

1. Lu X and Chang R. “Polycythemia Vera. In: StatPearls. StatPearls Publishing (2023).
2. Regimbeau M., et al. “Genetic Background of Polycythemia Vera”. Genes 4 (2022): 637.
3. Tefferi A and Barbui T. “Polycythemia vera and essential thrombocythemia: 2021 update on diagnosis, risk-stratification and management”. American Journal of Hematology 12 (2020): 1599-1613.
4. Ong E., et al. “Cerebrovascular events as presenting manifestations of Myeloproliferative Neoplasm”. Revue Neurologique (Paris)11 (2016): 703-708.
5. Fleischman AG and Tyner JW. “Causal role for JAK2 V617F in thrombosis”. Blood23 (2013): 3705-3706.
6. Spivak JL. “Polycythemia vera, the hematocrit, and blood-volume physiology”. The New England Journal of Medicine 1 (2013): 76-78.
7. How J., et al. “Biology and therapeutic targeting of molecular mechanisms in MPNs”. Blood 16 (2023): 1922-1933.
8. Burattini M., et al. “Ischemic stroke as a presenting manifestation of polycythemia vera: a narrative review”. Reviews in the Neurosciences 3 (2022): 303-311.
9. Michiels JJ. “Erythromelalgia and vascular complications in polycythemia vera”. Seminars in Thrombosis and Hemostasis 5 (1997): 441-454.
10. Finazzi G and Barbui T. “How I treat patients with polycythemia vera”. Blood 12 (2007): 5104-5111.
11. Barbui T., et al. “In contemporary patients with polycythemia vera, rates of thrombosis and risk factors delineate a new clinical epidemiology”. Blood19 (2014): 3021-3023.
12. Tefferi A and Barbui T. “Polycythemia vera and essential thrombocythemia: 2021 update on diagnosis, risk-stratification and management”. American Journal of Hematology 12 (2020): 1599-1613.
13. Cao YY., et al. “Hemorrhagic transformation after acute ischemic stroke caused by polycythemia vera: Report of two case”. World Journal of Clinical Cases 25 (2021): 7551-7557.
14. Balagopal K., et al. “Polycythemia Vera Presenting as Hemorrhagic Stroke”. Journal of Neurosciences in Rural Practice 3 (2021): 601-602.
15. Hasui H., et al. “Recurrent and Multiple Intracerebral Hemorrhages in Polycythemia Vera Secondary to Myelofibrosis: A Case Report and Literature Review”. Case Reports in Neurology 14 (2022): 274-280.
16. Chen L., et al. “Cerebral Hemorrhage of a 50-Year-Old Female Patient with Polycythemia Vera”. Journal of Stroke and Cerebrovascular Diseases 8 (2019): e110-e112.
17. Ryle JA. “Case of Erythraemia (Polycythaemia Vera, Vaquez-Osler’s Disease), with Cerebral Haemorrhage”. Proceedings of the Royal Society of Medicine 16 (1923): 83-84.
18. Wang N., et al. “Acute multiple cerebral infarction combined with cerebral microhemorrhage in Polycythemia vera: A case report”. Experimental and Therapeutic Medicine 4 (2019): 2949-2955.
19. Russi G and Marson P. “Urgent plasma exchange: how, where and when”. Blood Transfusion (2011).
20. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue - Padmanabhan”. Journal of Clinical Apheresis - Wiley Online Library (2023).
21. A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis - McMullin”. British Journal of Haematology - Wiley Online Library (2020).
22. Tefferi A., et al. “Polycythemia vera: historical oversights, diagnostic details, and therapeutic views”. Leukemia 12 (2021): 3339-3351.
23. Tefferi A. “Annual Clinical Updates in Hematological Malignancies: a continuing medical education series: polycythemia vera and essential thrombocythemia: 2011 update on diagnosis, risk-stratification, and management”. American Journal of Hematology 3 (2011): 292-301.
24. Griesshammer M., et al. “Thromboembolic events in polycythemia vera”. Annals of Hematology 5 (2019): 1071-1082.
25. Iurlo A., et al. “New Perspectives on Polycythemia Vera: From Diagnosis to Therapy”. International Journal of Molecular Sciences 16 (2020): 5805.
26. Zangari M., et al. “Could Hypoxia increase the prevalence of thrombotic complications in Polycythemia Vera?” Blood Coagulation and Fibrinolysis: An International Journal in Haemostasis and Thrombosis 3 (2013): 311-316.
27. Ortiz-Prado E., et al. “Chronic high-altitude exposure and the epidemiology of ischaemic stroke: a systematic review”. BMJ Open 4 (2022): e051777.
28. Fluids for people with stroke.
29. Suwanwela NC., et al. “A randomized controlled study of intravenous fluid in acute ischemic stroke”. Clinical Neurology and Neurosurgery 161 (2017): 98-103.
30. Lin J., et al. “Hydration prevents chronic hyperglycaemic patients from neurological deterioration post-ischaemic stroke”. Acta Neurologica Scandinavica 6 (2018): 557-565.
31. Bhatia K., et al. “Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity”. Indian Journal of Medical Research 3 (2015): 299-307.
32. Miller JB., et al. “Volume of Plasma Expansion and Functional Outcomes in Stroke”. Neurocritical Care 2 (2017): 191-195.
33. Pelz JO., et al. “Fluid Balance Variations During the Early Phase of Large Hemispheric Stroke Are Associated With Patients’ Functional Outcome”. Frontiers in Neurology 10 (2019): 720.
34. Mullen MT., et al. “Cerebral Blood Flow Response During Bolus Normal Saline Infusion After Ischemic Stroke”. Journal of Stroke and Cerebrovascular Diseases 11 (2019): 104294.

Citation

Citation: Suneha Pocha., et al. “Acute Management of Stroke in Patients with Polycythemia Vera". Acta Scientific Neurology 6.12 (2023): 03-07.

Copyright

Copyright: © 2023 Suneha Pocha., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.