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Polycythaemia Vera — RACP Adult Medicine MCQ

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ModerateHaematologyPolycythaemia VeraRACP Adult Medicine

A 50-year-old man is found to have an incidental finding of haemoglobin 195 g/L, haematocrit 0.58, and WCC 14 × 10⁹/L with basophilia. His platelet count is 550 × 10⁹/L. Serum erythropoietin is suppressed. What is the most likely diagnosis?

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Correct answer: A — Polycythaemia vera

Erythrocytosis with suppressed EPO, leucocytosis, and thrombocytosis is highly suggestive of polycythaemia vera (PV). JAK2 V617F mutation is positive in ~95% of PV cases. A bone marrow biopsy with JAK2 testing should be performed. Management includes phlebotomy (target haematocrit <0.45), low-dose aspirin, and cytoreductive therapy (hydroxyurea) for high-risk patients (age >60 or prior thrombosis).

Reference: eTG – 2025 – Haematology; WHO – 2022 – MPN Classification