Masked polycythaemia vera presenting with extensive splanchnic venous thrombosis and mesenteric ischaemia.
Rene A Amadore, Jerome A Anopol, Deonne Thaddeus V Gauiran
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Case in brief
A woman in her 60s with masked polycythaemia vera (PV) presented with extensive splanchnic venous thrombosis and mesenteric ischaemia after 5 years of management with phlebotomy and aspirin. Chronic iron deficiency had obscured her erythrocytosis, delaying diagnosis. She underwent exploratory laparotomy and jejunal resection. Diagnosis was confirmed via bone marrow biopsy and JAK2 V617F testing. Anticoagulation and hydroxyurea were initiated, leading to sustained haematologic control and thrombus regression.
Diagnostic / clinical pearl
Chronic iron deficiency can mask erythrocytosis in polycythaemia vera, complicating diagnosis and management.
Why it matters
This case highlights the importance of considering polycythaemia vera in patients with unexplained splanchnic venous thrombosis, especially when chronic iron deficiency is present.