“In oncology, polycythaemia vera (PV) is an uncommon myeloproliferative neoplasm in which the bone marrow makes too many red blood cells. Approximately 98% of PV patients have a JAK2 gene mutation in their blood-forming cells (compared with 0.1-0.2% of the general population)”

Before this afternoon I had no idea that a standard way of taking a bone marrow biopsy is as illustrated below. Careful what you dream…

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The main diagnostic criteria for polycythaemia are:

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My haemoglobin level is 17.4 g/dL and my haematocrit is 49%. This meets the criteria {just}. The next steps in diagnoses are bone marrow biopsy and a genetic search for JAK 2 mutation.

The treatment for actual disease, secondary polycythaemia and haemochromatosis is phlebotomy and aspirin. One of the markers for secondary polycythaemia is hypoxia. This measured from the arterial blood. These consistent with the bloodletting part of the dream. Mid-week I will find out if I have HFE gene mediated haemochromatosis. This may exclude PV.

PV is associated with a reduced life expectancy and can change into to some seriously nasty stuff. Thick gloopy blood has an increased tendency to clot. Hence PV has implications for hip surgery if that goes ahead.

I have mild hypothyroidism according to the blood work but I am asymptomatic. There is no smoking gun for osteoporosis. A problem with bone marrow Myeloid tissue could be a factor in the osteoporosis diagnosed recently. If the marrow is making too many red blood cells it could be neglecting its other duties {naively}. The bone may not be thick enough.

If there is no JAK2 problem things get scientifically very complex very quickly. Most likely they will diagnose secondary polycythaemia. It is a moot point if we will go down the JAK2 route. Fat, fags and beer being the holy trinity, plus COPD. This looks the most probable. Maybe we do need to rule it , JAK 2, out, though.

PV if diagnosed is rare with an estimated occurrence of 22 per 100,000, which means that most GPs may never see it. It is hereditary to an extent which could suggest some geographical clustering. I may have a follow up on the HFE genetic results due.

In a sense the dream is preparing me for more medical merry-go-round.

I need to get my head clear because we are meeting the orthopaedic surgeon about “bionic” hips tomorrow. What happens next is fairly pivotal for my/our thinking…

As an aside of late I have been dreading opening up a news web site like “The Guardian” of a morning. This morning the thought was “what unpleasantness has Trump unleashed on the world overnight?” He got to ejaculate his big bombs over Iran.

The United Nations has rarely looked so helpless. A dream of unity peace and togetherness after the brutality of World War has been shat upon time after a time. People forget…

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