# Benign or uncertain blood-related neoplasm (including polycythaemia vera)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD26 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Polycythemia Vera - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK557660/
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
BENIGN OR UNCERTAIN BLOOD-RELATED NEOPLASM (INCLUDING POLYCYTHAEMIA VERA)
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD26 -
         condition scope only, no dose · No dose - referral pathway, no medicine given in primary
         care · Polycythemia Vera - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK557660/
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (6)
    - Complaints: tiredness, headache, dizziness, ringing in the ears, altered vision, poor sleep,
      calf pain on walking, itch, gastritis, filling up quickly  [claudication · dizziness · fatigue
      · headache · insomnia · itching · tinnitus]
    - Itch that starts during or soon after a hot shower troubles 40% of patients  [itching]
    - Burning pain in hands and feet, either reddened or pale  [burning pain · pallor · redness]
    - Bleeding shows as nosebleeds, bleeding gums, or blood loss from the gut  [bleeding · gum
      bleeding · nosebleed]
    - Clots show as DVT, pulmonary embolism, Budd-Chiari, splanchnic vein thrombosis, stroke,
      arterial thrombosis
    - Filling up early comes from a big spleen limiting how much the stomach holds
  SIGNS - what you find (2)
    - Ruddy flushed face and palms, red eyes, and scratch marks over the skin
    - An enlarged spleen and liver are often found  [splenomegaly]
  TESTS (8)
    - In men haemoglobin above 16.5 g/dL or haematocrit above 49%; in women above 16 g/dL or above
      48%
    - Alternatively a red cell mass more than 25% above the predicted normal mean
    - Marrow biopsy: too many cells for age, growth across all three lines, with varied mature
      megakaryocytes
    - A JAK2 V617F or exon 12 mutation is the third major criterion
    - The minor criterion is a serum erythropoietin under the normal range
    - Diagnosis needs all three major criteria, or two major plus the minor one
    - Apply the criteria only once secondary causes have been excluded
    - True polycythaemia vera needs raised output in all three cell lines
  IF NOT THIS - what else fits (5)
    - Secondary polycythaemia from low oxygen or smoking is far commoner and must be excluded first
    - A raised red cell mass alone is not diagnostic; chronic hypoxia and EPO-secreting tumours do
      it too
    - A rare EPO-receptor mutation copies the picture, with high red cell mass and low EPO
    - Granulocytosis alone follows infection or a leukaemoid reaction; a lone high platelet count
      follows bleeding or iron lack
    - Other myeloid neoplasms: essential thrombocythaemia, CML, agnogenic myeloid metaplasia,
      primary myelofibrosis
  Source  StatPearls "Polycythemia Vera" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Includes polycythaemia vera, diagnosed and managed by haematology (phlebotomy,
            cytoreductive therapy); a GP refers for diagnosis and may continue low-dose aspirin for
            clot prevention once a haematologist has established the diagnosis and plan. - Refer,
            with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Includes polycythaemia vera, diagnosed and managed by haematology (phlebotomy,
            cytoreductive therapy); a GP refers for diagnosis and may continue low-dose aspirin for
            clot prevention once a haematologist has established the diagnosis and plan.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Facial plethora with itching after a hot bath (polycythaemia vera),
            thrombosis or stroke-like symptoms, a very high haemoglobin or haematocrit on routine
            bloods, or splenomegaly: assess urgently and refer.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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