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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 7090% 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