Question

A 60-year-old man presents to the office for routine follow-up of hypertension.

A CBC reveals:
WBC 12.0 x 103/mm3 4.5 - 11
RBC 7.0 x 106/μl 4.6 - 6.2 (male)
Hematocrit 60 % 40 - 54 (male)
MCV 68 μ3 80 - 100
RDW 14.9 % 11.6 - 14.6
Platelets 550,000 mm3 150,000 - 450,000

On examination, blood pressure is 160/88 mm Hg, pulse is 86/min, temperature 97.6°F, and respirations 18/minute. His skin appears ruddy and the tip of the spleen is palpable. Pulse oximetry reveals a saturation of 99%.

What is the most likely diagnosis?

Answer 1

The 60-year-old hypertensive male with high RBC, hematocrit, and platelet counts likely has Polycythemia Vera, a myeloproliferative disorder requiring a hematologist's evaluation.

Step-by-step explanation:

The patient with hypertension also presents with a Complete Blood Count (CBC) that shows elevated RBC count, hematocrit, and platelet count. The presentation of ruddy skin and a palpable spleen tip, alongside these hematologic findings, suggests a possible diagnosis of Polycythemia Vera (PV). PV is a myeloproliferative disorder characterized by an increase in red blood cells, white blood cells, and platelets. This can lead to hyperviscosity of the blood and subsequently to hypertension due to the increased resistance within the blood vessels. The patient's blood pressure is 160/88 mm Hg, which is indicative of hypertension. Given the clinical picture and lab results, coordinating care with a hematologist for further evaluation and management of PV is advisable.