What history questions should be asked to a patient with polycythemia?

Key History Questions for Patients with Polycythemia Vera

When evaluating a patient with polycythemia vera (PV), a comprehensive set of targeted history questions should focus on thrombotic risk factors, disease-related symptoms, and potential secondary causes of erythrocytosis.

Thrombotic Risk Assessment

• Age (>60 years is a major risk factor) 1
• Previous history of thrombotic events (arterial or venous) 1, 2
• Cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, smoking) 2
• Family history of thrombotic events 3
• Symptoms of microvascular disturbances:
  • Erythromelalgia (burning pain in extremities) 3, 4
  • Transient visual changes or disturbances 4
  • Headaches or dizziness 2

Disease-Related Symptoms

• Pruritus, especially after warm showers or baths 1, 4
• Constitutional symptoms:
  • Fatigue 5
  • Weight loss
  • Night sweats
  • Fever
• Abdominal discomfort or early satiety (suggesting splenomegaly) 4
• Symptoms of hyperviscosity:
  • Blurred vision
  • Headache
  • Dizziness
  • Tinnitus
• Bleeding tendency or unusual bruising (may indicate acquired von Willebrand disease with extreme thrombocytosis) 4

Secondary Causes of Erythrocytosis

• Smoking history (can cause secondary erythrocytosis) 5
• Sleep apnea symptoms (snoring, daytime somnolence) 5
• High altitude residence or recent travel 1
• Use of testosterone or anabolic steroids 5
• Use of erythropoietin or other performance-enhancing drugs 1
• History of chronic lung disease (COPD) 1
• History of congenital heart disease 1

Medication History

• Current medications, including over-the-counter drugs 1
• Previous treatments for PV (if diagnosed previously):
  • Phlebotomy frequency and tolerance 1, 4
  • Prior cytoreductive therapies (hydroxyurea, interferon, etc.) 1
  • Response to treatments and any side effects 1
• Use of aspirin or anticoagulants 4, 2

Past Medical History

• History of other myeloproliferative disorders 2
• History of splenectomy 1
• Renal or hepatic disease 1
• Prior bone marrow examinations or genetic testing results (JAK2 mutation) 4, 2
• History of leg ulcers (may affect hydroxyurea treatment decisions) 1

Social History

• Alcohol consumption
• Tobacco use (important both as secondary cause and cardiovascular risk factor) 1
• Occupation and activity level
• Impact of symptoms on quality of life

Family History

• Family history of polycythemia or other myeloproliferative disorders
• Family history of early thrombotic events

Reproductive History (for women)

• Pregnancy history and complications 6, 2
• Menstrual history (heavy bleeding may affect iron status)
• Use of hormonal contraceptives (may increase thrombotic risk)

Common Pitfalls to Avoid

1. Failing to distinguish between primary (PV) and secondary causes of erythrocytosis
2. Not assessing thrombotic risk factors comprehensively
3. Overlooking symptoms of hyperviscosity that may require immediate intervention
4. Missing medication history that could affect treatment decisions
5. Not inquiring about tolerance to previous treatments, especially phlebotomy

By systematically addressing these key areas in the history, clinicians can better assess disease severity, thrombotic risk, and guide appropriate management decisions for patients with polycythemia vera.