A 62-year-old man presents for his annual health maintenance visit. The review of systems is…

A 62-year-old man presents for his annual health maintenance visit. The review of systems is positive for occasional fatigue and headache. The patient admits to generalized pruritus following a warm bath or shower. He has plethora and engorgement of the retinal veins. A spleen is palpable on abdominal examination. The patient’s hematocrit is 63%, and he has a leuko-cytosis and thrombocytosis. Peripheral blood smear is normal. The patient does not smoke. Which of the following is the most likely diagnosis? a. Essential thrombocytosis b. Myelofibrosis c. Spurious polycythemia d. Polycythemia vera e. Secondary polycythemia

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