Objectives:

• Recognize the common myeloproliferative disorders and their manifestations
• Differentiate between primary and secondary polycythemia
• Recognize transformation of myeloproliferative disorders
• Evaluate a patient with an elevated hemoglobin or platelet count

1		A 30-year-old female presents to your office for a follow-up visit after hospitalization for an appendectomy. At the time of surgery, her platelet count was found to be 1,500,000/mm3. She has no other past medical history. She takes no medications, does not smoke, drinks alcohol only rarely, and exercises 3 times a week. She presents today for follow-up, feeling well. You repeat the CBC, showing WBC 5,000/mm3, hemoglobin 13 g/dL, and platelet count 800,000/mm3. What is your next step in managing this patient?
			A)	Observation and periodic evaluation of her CBC.
			B)	Initiation of hydroxyurea 500 mg BID.
			C)	Counseling against becoming pregnant.
			D)	Anticoagulation with warfarin to a goal INR 2-3.
			E)	No further evaluation or follow-up necessary.