Improvised Management of Polycythemia Vera Using Whole Blood Transfusion Kits

Polycythemia vera (PV) is a frequent myeloproliferative disease resulting in excessive red blood cells, white blood cells, and platelets rarely identified in military populations. Increased blood viscosity and platelets can lead to fatal myocardial infarction and stroke. Historically, regimented phlebotomy managed this condition, but modern medicinal advances now are utilized. These immunosuppressive medications are generally incompatible with active-duty service and can lead to medical discharge. Phlebotomy therefore is critical for readiness and health; however, this can be challenging in resource-limited environments, necessitating effective improvisation. We describe an active-duty Soldier with PV symptoms consisting of substernal chest pressure, bilateral lower extremity paresthesias, and persistent pruritic neck rash. He had an elevated hematocrit (Hct) of 47%, necessitating phlebotomy and posing a challenge to his primary care team. The local emergency medicine team employed blood collection bags from whole blood (WB) transfusion kits, including proven volume estimation methods, to routinely draw one unit of blood and effectively manage this condition. This is the first reported case in military literature of PV managed with improvised field resources and techniques.