Severe Spontaneous Hemoperitoneum in Polycythemia Vera

Abstract

Although bleeding may found in polycythemia vera (PV), spontaneous hemoperitoneum as in our patient is very unusual. A 73-year-old Thai woman had been diagnosed as PV for four years based on hemoglobin of 19.9 g%, the presence of JAK2 V617F mutation and the panmyelosis in the bone marrow biopsy but she lost follow-up since then. At presence, she suddenly developed left sided abdominal pain with large ecchymosis and fever for one day. The physical examination revealed frank pallor, large hematoma and bulging of left sided abdomen due to a huge mass extending to the left iliac crest. The blood test showed Hb 7.9 g%, WBC 43,800/mm³, platelet 1,060,000/mm³. The computed tomography of the abdomen revealed massive hemoperitoneum and splenomegaly. The angiographic catheterization revealed the large hemangioma at the spleen with oozing. She was finally diagnosed as massive hemoperitoneum. And despite full treatment options, she could not survive.