# Polycythaemia (Erythrocytosis Investigation & Referral)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: BSH Guideline for the Diagnosis and Management of Polycythemia Vera 2019
- Verified date: 2026-08

## Verified against

- BSH Guideline for the Diagnosis and Management of Polycythemia Vera 2019
- Polycythaemia (Erythrocytosis Investigation & Referral) - disease-level clinical article (polycythemia-referral-clinical.txt)

## Treatment metadata

- Acetylsalicylic acid — 75 mg — oral.solid
- Referral & safety-netting (no drug therapy)

## Complete treatment card

```text
POLYCYTHAEMIA (ERYTHROCYTOSIS INVESTIGATION & REFERRAL)
Sources: BSH Guideline for the Diagnosis and Management of Polycythemia Vera 2019
Review status: REVIEWED against BSH Guideline for the Diagnosis and Management of Polycythemia Vera
               2019, Polycythaemia (Erythrocytosis Investigation & Referral) -
               disease-level clinical article (polycythemia-referral-clinical.txt)
               (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (5)
    - Symptoms from hyperviscosity include fatigue, headache, dizziness, tinnitus, visual change,
      claudication, itching, and early fullness after eating.  [claudication · dizziness · fatigue ·
      headache · itching · tinnitus]
    - Itching triggered by a hot shower, aquagenic pruritus, affects about 40% of patients.
      [itching]
    - Erythromelalgia causes burning hand and foot pain with redness or pallor of the skin.  [foot
      pain · pallor · redness]
    - Bleeding and clotting complications each occur in roughly 1% of patients.  [bleeding]
    - Feeling full quickly after eating results from an enlarged spleen crowding the stomach.
      [early satiety · splenomegaly]
  SIGNS - what you find (1)
    - Exam may show facial and palm flushing, red conjunctivae, scratch marks from itching, and an
      enlarged spleen or liver.  [itching · splenomegaly]
  TESTS (5)
    - WHO major criteria include hemoglobin above 16.5 g/dL in men (16 in women), or hematocrit
      above 49%/48%, or red cell mass over 25% above predicted.
    - Bone marrow biopsy shows age-inappropriate hypercellularity with growth in all three cell
      lines and pleomorphic megakaryocytes.
    - A JAK2 V617F or exon 12 mutation is required as a major diagnostic criterion.
    - A low serum erythropoietin level below the normal reference range is the minor diagnostic
      criterion.
    - The diagnostic criteria are applied only once secondary causes of polycythemia have been
      excluded.
  IF NOT THIS - what else fits (4)
    - Because it's driven by hypoxia or smoking, secondary polycythemia occurs far more often than
      primary PV and must always be ruled out first.
    - A rare EPO-receptor mutation mimics PV's raised red cell mass and low EPO, but works through
      an over-sensitive receptor rather than EPO-independent growth.
    - An isolated high white count can be from infection or a leukemoid reaction, and isolated high
      platelets from bleeding or iron deficiency.
    - Other diagnoses named to distinguish include essential thrombocythemia, chronic myelogenous
      leukemia, and primary myelofibrosis.
  Source  StatPearls "Polycythemia Vera" - disease-level clinical article
  Status  traced to the source above

1. ACETYLSALICYLIC ACID                                   [1st line]
   Adult    75-100 mg once daily with food - long-term under haematologist monitoring
   Peds     CONTRAINDICATED in children under 16 years due to Reye's syndrome risk
   Source   BSH Guideline for the Diagnosis and Management of Polycythemia Vera 2019
   Why      Low-dose aspirin reduces arterial and venous thrombotic events in polycythemia vera
   Caution  SPECIALIST HAEMATOLOGY REFERRAL IS MANDATORY for hematocrit >0.52 in men or >0.48 in
            women.
            Primary treatment for polycythemia vera is therapeutic venesection (target hematocrit
            <0.45) under haematology guidance.
            Differentiate primary polycythemia vera (JAK2 mutation) from secondary erythrocytosis
            (chronic hypoxia, smoking, OSA, renal tumors).
            Take aspirin with food to reduce GI bleeding risk.
   Egypt    AGGREX 75MG 60 TABS.             RAMEDA              33.00 EGP (0.55/unit)
            ASPOCID 75MG 20 TAB.             CID                 22.00 EGP (1.10/unit)
            ASPOCID 75MG 30 TAB.             CID                 33.00 EGP (1.10/unit)
            ASPIRIN-CHEMIPHARM 75 MG 30 CHEW.TABS. CHEMIPHARM                              12.00 EGP
            RIVO 75 MG 30 CHEW. TABS.        ARAB DRUG COM...    21.00 EGP
            ASPOCID PAEDIATRIC 75MG 30 CHEW. TABS. CID                                     35.00 EGP
            EZACARD 75 MG 30 E.C. TABS.      MULTI-APEX          51.00 EGP

2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)            [1st line]
   Adult    
   Source   Polycythaemia (Erythrocytosis Investigation & Referral) - disease-level clinical article
            (polycythemia-referral-clinical.txt)
   Why      Carries the referral criteria and warning signs for this condition, which apply
            whichever treatment is chosen.
   Caution  RED FLAG - Aspirin is contraindicated in patients with extreme thrombocytosis (platelets
            >1 million/microliter) due to acquired von Willebrand disease.

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

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