PRIMARY POLYCYTHEMIA-VERA IN THE ELDERLY

At presentation the history of an 87-year-old woman included progressi ve memory loss, repeated transient ischaemic attack, increasing fatigu e, dizziness, palpitations and frequent falls. Investigations revealed erythrocytosis, leukocytosis, thrombocytosis, normal arterial oxygen concentration and an increased red cell volume. Polycythaemia vera was diagnosed and was successfully managed by phlebotomy with half a unit twice a week and rechecks of her haematocrit, initially; she reported marked improvement after 2 weeks of treatment. The alternative treatm ents for polycythaemia vera are discussed; in addition to venesection, conventional treatments include bone-marrow depressive agents such as phosphorus-32 and chemotherapy with agents such as hydroxyurea. More recent developments include isovolumic erythrocytophoresis, alpha-inte rferon and ticlopidine. All of the treatments are associated with comp lications, or other disadvantages, thrombotic complications in the cas e of phlebotomy, malignancies in the case of most myelosuppressive tre atments, and problems of compliance in others. The optimal treatment f or polycythaemia vera is a judicious combination of the alternatives, depending on the phase of the disease, the age of the patient, and oth er prognostic factors.