03-02-2008, 02:29 PM
A 50-year-old man is evaluated for the recent onset of pruritus while showering. He has previously been in excellent health, eats a normal diet, has never smoked, and does not take any medications.
On physical examination, there are ruddy facies and a palpable spleen tip. Results of fecal occult blood testing are negative. The oxygen saturation at rest is 99% on room air.
Laboratory studies indicate a hematocrit of 61.0% compared with a value of 44.5% documented 5 years ago, leukocyte count of 11,100/μL (11.1 × 109/L), mean corpuscular volume of 79 fL, and platelet count of 550,000/μL (550 × 109/L). Serum chemistries are normal except for a reduced serum iron saturation and serum ferritin concentration. Results of upper and lower endoscopy are normal.
Which of the following is the most appropriate management of this patient?
A Phlebotomy and anagrelide
B Oral iron supplementation and low-dose aspirin
C Hydroxyurea and aspirin, 325 mg/d
D Phlebotomy and low-dose aspirin
On physical examination, there are ruddy facies and a palpable spleen tip. Results of fecal occult blood testing are negative. The oxygen saturation at rest is 99% on room air.
Laboratory studies indicate a hematocrit of 61.0% compared with a value of 44.5% documented 5 years ago, leukocyte count of 11,100/μL (11.1 × 109/L), mean corpuscular volume of 79 fL, and platelet count of 550,000/μL (550 × 109/L). Serum chemistries are normal except for a reduced serum iron saturation and serum ferritin concentration. Results of upper and lower endoscopy are normal.
Which of the following is the most appropriate management of this patient?
A Phlebotomy and anagrelide
B Oral iron supplementation and low-dose aspirin
C Hydroxyurea and aspirin, 325 mg/d
D Phlebotomy and low-dose aspirin