Abyad A, Kligman E
Department of Family Medicine, American University of Beirut, Lebanon.
J Int Med Res. 1994 Mar-Apr;22(2):121-9. doi: 10.1177/030006059402200209.
At presentation the history of an 87-year-old woman included progressive memory loss, repeated transient ischaemic attack, increasing fatigue, 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 treatments 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-interferon and ticlopidine. All of the treatments are associated with complications, or other disadvantages, thrombotic complications in the case of phlebotomy, malignancies in the case of most myelosuppressive treatments, and problems of compliance in others. The optimal treatment for polycythaemia vera is a judicious combination of the alternatives, depending on the phase of the disease, the age of the patient, and other prognostic factors.
一位87岁女性就诊时的病史包括进行性记忆力减退、反复短暂性脑缺血发作、疲劳加重、头晕、心悸和频繁跌倒。检查发现红细胞增多、白细胞增多、血小板增多、动脉血氧浓度正常且红细胞体积增加。诊断为真性红细胞增多症，最初通过每周两次每次放血半单位并复查血细胞比容成功进行治疗；她报告治疗2周后有明显改善。文中讨论了真性红细胞增多症的其他治疗方法；除放血外，传统治疗包括骨髓抑制药物如磷-32以及化疗药物如羟基脲。最近的进展包括等容红细胞单采术、α-干扰素和噻氯匹定。所有这些治疗都伴有并发症或其他缺点，放血会导致血栓形成并发症，大多数骨髓抑制治疗会导致恶性肿瘤，其他治疗则存在依从性问题。真性红细胞增多症的最佳治疗方法是根据疾病阶段、患者年龄和其他预后因素明智地联合使用这些替代方法。
