ABSTRACT
Polycythemia vera (PV) is a chronic myeloproliferative disease characterized by an increase in the total mass of red cells. Leukocyte and platelet counts are often elevated as well. The most common complication is thrombosis, which usually involves brain, heart, gastrointestinal tract, and kidneys, but rarely involves spleen. The cornerstone of therapy for this disease is phlebotomy and it is associated with an increased risk of thrombosis, especially for patients older than 70 years, those with a history of thrombosis, and those requiring an increased frequency of phlebotomy. Concurrent treatment with myelosuppressive agents decreases the risk of thrombotic complications.Recently we experienced a case of multiple splenic infarction in PV treated phlebotomy alone in a 42-year old woman who had complained of massive splenomegaly, left upper quadrant abdominal pain and fever. CT scan of abdomen showed multiple hypodense areas suggesting splenic infarction. She was managed with hydroxyurea and salicylate instead of phlebotomy and showed a clinical improvement with lowering the platelet count and reducing splenomegaly. PV with a assive splenomegaly is prone to thrombosis and phlebotomy in such patients may contribute to the thrombotic complications by increasing platelet counts. When it is necessary to lower the platelet count or reduce splenomegaly, hydroxyurea may be more useful than phlebotomy.