18th August 2024

A 62-year-old gentleman presents with weakness of the left arm which he noticed when he woke up

A 62-year-old gentleman presents with weakness of the left arm which he noticed when he woke up. He had been well when he went to bed at 10pm and thought that his symptoms would resolve so did not present until later that morning. He has been well recently other than occasional itching after showering. He has a past medical history of hypertension, asthma and is an ex-smoker, quitting 20 years ago. On examination, he is alert and comfortable but appears slightly plethoric. He has power of MRC grade 4/5 in his left arm, reduced sensation in his left arm and is dysarthric. Blood tests show a haemoglobin of 190 g/L (130-180 g/L), WCC 12 x109 (3.6-11.0 x10⁹) and platelets of 452 x10⁹ (140-400 x10⁹). He has a normal prothrombin time and activated partial thromboplastin time. Further testing reveals a JAK2 V617F mutation and a low serum erythropoietin level.

What treatment should the patient be commenced on prior to discharge?

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