Splenic infarction in polycythaemia vera: can the spleen be saved?

Polycythaemia vera is associated with thrombotic phenomenon due to hyperviscosity of blood. Splenic infarction with splenomegaly is a catastrophic complication usually requiring splenectomy. We describe a case of splenic infarction as an initial manifestation of polycythaemia vera which was treated with serial phlebotomies and hydroxyurea alone, without the need for surgery.