Walsh & Hoyt: General Clinical Manifestations

Headaches, light-headedness, weakness, perspiration, and epigastric discomfort are common symptoms of polycythemia vera. These symptoms apparently are related to increased blood viscosity and hypervolemia. Epistaxis, spontaneous bruising, and upper gastrointestinal hemorrhage are ascribed to the effects of hypervolemia and platelet dysfunction. Peptic ulcer disease and pruritus occur with increased frequency in patients with polycythemia vera, presumably from increased histamine release caused by excessive turnover of granulocytes, particularly basophils. The pruritus is often especially severe after a hot bath. Symptomatic bone pain and tenderness, particularly of the ribs and sternum, are occasionally severe and reflect panhyperplasia of the bone marrow