Splenic Infarctions in Polycythaemia Vera are Not Always a Catastrophe

Splenic infarction can occur as an infrequent thrombotic manifestation in polycythaemia vera (PV) and is usually catastrophic. We describe the case of a middle-aged woman who was diagnosed with PV 3 months before she presented to the emergency department with acute limb ischaemia. A splenic infarction detected on diagnostic imaging during her hospital stay was treated conservatively with modification of her hydroxyurea dose along with pain management, without the need for surgery. LEARNING POINTS: Multiple splenic infarctions are an uncommon presentation in polycythaemia vera. Patients can present with vague abdominal pain, so a high index of suspicion is necessary and diagnosis is usually radiological. Splenic infarction in polycythaemia patients can be treated successfully with hydroxyurea and pain management with aspirin.