Masked polycythaemia vera presenting with extensive splanchnic venous thrombosis and mesenteric ischaemia.

Authors

Rene A Amadore, Jerome A Anopol, Deonne Thaddeus V Gauiran

Published in

BMJ case reports. Volume 19. Issue 9. Sep 30, 2026. Epub Sep 30, 2026.

Abstract

Splanchnic venous thrombosis (SVT) is a potentially catastrophic manifestation of polycythaemia vera (PV). We report a woman in her 60s with masked PV who had been managed for 5 years with intermittent phlebotomy and aspirin without haematology referral, molecular testing or cytoreductive therapy. Chronic iron deficiency masked erythrocytosis, delaying diagnosis. She presented with extensive thrombosis involving the portal, splenic and superior mesenteric veins complicated by mesenteric ischaemia requiring exploratory laparotomy, jejunal resection and ileostomy. Bone marrow biopsy and JAK2 V617F testing confirmed PV. Therapeutic anticoagulation was initiated with enoxaparin and subsequently transitioned to apixaban, while hydroxyurea achieved sustained haematologic control. Interval imaging demonstrated thrombus regression with persistent cavernous transformation. Given ongoing portal hypertension, oesophageal varices, occasional mild ostomy bleeding and low body weight, anticoagulation was continued indefinitely at reduced intensity with apixaban 2.5 mg twice daily. At 21-month follow-up, the patient remained free of recurrent thrombosis and major bleeding.

PMID:
42816104
Bibliographic data and abstract were imported from PubMed on 01 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.