Abstract
Advanced practitioners (APs) play an integral role in early identification, diagnosis, and treatment of patients with polycythemia vera (PV). This Grand Rounds article highlights the case of a younger patient who presented with a spontaneous splanchnic vein thrombus without obvious cause. The most recent updates to the World Health Organization diagnostic criteria for PV increase the likelihood of identifying masked PV; however, there are some scenarios where the hemoglobin and hematocrit criteria will not be met. Developing individualized treatment plans based on comorbidities, socioeconomic factors, compliance, tolerance, menstrual status, and future childbearing desires allows the advanced practitioner to provide the best care for patients with PV.