Experts highlight need for broader monitoring in polycythemia vera as patient shows disease progression despite controlled hematocrit

A 68-year‑old woman with a six‑year history of polycythemia vera (PV) and prior deep‑vein thrombosis has kept her hematocrit below 45% on hydroxyurea, indicating good control of that metric.

Despite stable hematocrit, recent labs show a rising white blood cell count to 16,000 and imaging reveals enlarging spleen. She now experiences worsening fatigue, night sweats, early satiety and a lower quality of life.

Clinicians note that relying solely on hematocrit can miss disease activity. They recommend objective tracking of blood counts and symptom burden, and suggest adjusting therapy beyond phlebotomy and hydroxyurea dose escalation when needed.

The case underscores the importance of individualized treatment strategies for PV patients whose disease progresses despite conventional hematocrit targets.