Which of the following is a clinical feature of polycythemia vera?

ISRO- 2016

Medical & Surgical Nursing

Easy

Appeared in: ISRO- 2016

Explanation

Polycythemia Vera (PV) is a myeloproliferative neoplasm defined by the excessive production of red blood cells by the bone marrow.
This primary overproduction leads to an increased total red cell mass, which is a core feature of the disease.
Consequently, laboratory findings consistently show elevated hemoglobin and hematocrit levels.
The spleen becomes enlarged (splenomegaly), often massively, due to the increased workload of filtering the excess red blood cells and from extramedullary hematopoiesis.
Because all the listed options are classic and defining features of PV, the most comprehensive and correct answer is 'All of the above'.

Option A: While massive splenomegaly is a significant clinical feature of PV, it is not the only one. Selecting this option alone is incomplete as it ignores the fundamental hematological abnormalities.
Option B: Elevated hemoglobin and hematocrit are key laboratory markers but are consequences of the increased red cell mass. Choosing this option overlooks other important clinical signs like splenomegaly.
Option C: An elevated red cell mass is the defining pathophysiological characteristic of PV. However, the question asks for clinical features, which also include the consequences and physical signs resulting from this, such as splenomegaly and abnormal lab values.

Clinical Relevance

Nursing practice connection: Knowing Clinical manifestations of Polycythemia Vera helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
The primary nursing concern for patients with PV is monitoring for and preventing thromboembolic events (e.g., stroke, heart attack, DVT, pulmonary embolism) due to hyperviscosity.
Patient education is a key nursing role, focusing on the importance of hydration, adherence to phlebotomy schedules, avoiding iron supplements (unless prescribed), and recognizing the signs and symptoms of both clotting and bleeding.
Nurses should assess for symptoms related to hyperviscosity, such as headaches, dizziness, visual disturbances, and pruritus (itching), and manage them as prescribed.

How to Approach the Question

First, identify the core subject of the question: the clinical features of Polycythemia Vera (PV).
Recall the basic pathophysiology of PV, which is the overproduction of red blood cells (erythrocytes).
Evaluate each option in light of this core concept.
Option A (Massive splenomegaly): Consider the spleen's function. Does filtering an excessive number of red blood cells cause it to enlarge? Yes, this is a known complication.
Option B (Elevated Hgb/Hct): Consider the definition of hemoglobin and hematocrit. If there are too many red blood cells, will these values be high? Yes, this is a direct laboratory consequence.
Option C (Elevated red cell mass): Is this a feature of PV? Yes, it is the defining characteristic of the disease.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 627-629

E6 Medicine Harrison 22e Part 1 p. 860-862