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present in ~40% of PV patients Plethora (facial redness/ruddy complexion) due to increased RBC mass and skin hyperemia Headache, dizziness, and visual disturbances from hyperviscosity and reduced cerebral blood flow Splenomegaly palpable in 7090% of PV patients from extramedullary hematopoiesis Thrombotic events (DVT, stroke, MI, Budd-Chiari syndrome) major complications from hyperviscosity Erythromelalgia burning pain/redness of hands and feet due to platelet-mediated microvascular occlusion Gout from elevated uric acid due to increased cell turnover Hypertension common comorbidity in PV Bleeding tendency paradoxically, despite elevated platelets, qualitative platelet dysfunction can cause GI bleeding Signs and symptoms that are routinely associated with a confirmed diagnosis of anemia or polycythemia (e.g., tachycardia, fatigue, pallor with anemia

I hope its not as bad as the first shot

Its key for doctors to keep an eye on B12 levels to avoid missing the diagnosis and to act quickly

Its important that your healthcare provider documents the deficiency clearly to facilitate Medicare coverage

Its important to balance the good and bad for the best care

[10] [12] Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions