Authors: Ana Filipa Coimbra Trigo , Ana Rita Ramos , Márcia Melo

Abstract

Background: One of the main goals of treatment in polycythemia vera (PV) is the prevention of arterial and venous thrombosis. However, less commonly, patients may also experience hemorrhagic events. This case report aims to raise awareness of these complications. We describe a patient with PV who developed an acute non-traumatic subdural hematoma (SDH) - a rare presentation - with severe impact on life expectancy.

Case Presentation: A 53-year-old man, diagnosed with PV at the age of 46, presented to the emergency department with right arm weakness, which progressed to right leg weakness and dysarthria. Computed tomography revealed a large acute interhemispheric SDH requiring craniotomy. During hospitalization, the patient had persistent leukocytosis above 16×10⁹/L. He did not recover consciousness and was discharged with a Glasgow Coma Scale (GCS) score of 9.

Conclusion: Hemorrhagic complications in PV may result from antiplatelet or anticoagulant therapy, acquired Von Willebrand Syndrome (aVWS), or platelet dysfunction. Additional risk factors include age at diagnosis, disease duration, prior bleeding, and leukocytosis (particularly > 16×10⁹/L). Our patient presented multiple risk factors for bleeding. Earlier recognition of hemorrhagic risk might have prompted changes in therapy and potentially improved prognosis. This case highlights the importance of considering hemorrhagic complications, in addition to thrombosis prevention, in patients with PV.

Keywords: Myeloproliferative disorders, polycythemia vera, hematoma, subdural, acute.