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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 70–90% 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
