The management of acute myocardial infarction in a patient with polycythemia rubra vera during the thrombolytic era--does it make a difference?

A 42-year-old man presented with acute anterior myocardial infarction and hemoglobin of 248 g/L. Laboratory studies suggested the diagnosis of polycythemia rubra vera (PRV). Management of this condition with acetylsalisylic acid, heparin, warfarin and phlebotomy constitutes a therapeutic dilemma. This case also brings up the question of the appropriateness of thrombolysis and angioplasty in the treatment of myocardial infarction in the presence of PRV. Due to the rarity of this hematological disease, a call for international collaboration for assessing the efficacy and safety of these treatment modalities is recommended.