ONC8 Splenomegaly with massive hemorrhagic infarction complicating polycythemia vera. (Oncology).

ONC8 SPLENOMEGALY WITH MASSIVE HEMORRHAGIC INFARCTION COMPLICATING POLYCYTHEMIA VERA. Darren R. Swenson, MD, Robert DiBenedetto, MD, and Ali R. Rahimi, MD. Department of Internal Medicine, Memorial Health University Medical Center, Savannah, Ga.

Of the four chronic myeloproliferative disorders, polycythemia vera is the most common at an incidence of 29 per 100,000. Complications include an increase in blood viscosity, splenomegaly, and intravascular thrombosis affecting multiple organ systems. A 55-year-old female with polycythemia vera presented with complaints of left upper quadrant abdominal pain. The patient had had a pulmonary embolism 1 year earlier and was taking coumadin for long-term anticoagulation. Her medications also included hydrea. She had a temperature of 102.5[degrees]F and a heart rate of 136/mm. Physical examination of the abdomen revealed diffuse voluntary guarding, left upper quadrant tenderness, and a palpable spleen approximately 4 cm below the left costal margin. Laboratory values were significant for WBC at 16,500/[mm.sup 3], hemoglobin 10,000/[mm.sup.3], hematocrit 34.1%, and platelets of 824,000/ [mm.sup.3] Computed tomography (CT) of the abdomen and pelvis with intravenous contrast showed a significant enlarged spleen with areas of massive infarction and hematoma. These results were compared with a previous CT scan 30 months earlier, which was normal. She was treated with analgesics. At the time of discharge, her protime was 14.1. Four weeks later, a repeat CT scan showed an increase in splenomegaly, with increasing infarction and hematoma. The patient was doing well and asymnptomatic Thromboembolism and infarction are known complications of polycythemia vera. Splenic infarction with hematoma usually requires no intervention. This case represents an unusually large hemorrhagic infarction of the spleen in a patient with polycythemia vera. A previous pulmonary embolism and treatment with coumadin complicated this patient's treatment because of an expanding hemorrhagic infarction and the increased risk for spontaneous rupture.