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January 16, 1978

Polycythemia Masking Carcinoma of Ascending Colon

JAMA. 1978;239(3):191-192. doi:10.1001/jama.1978.03280300023007

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To the Editor.—  One of the classic presenting features of carcinoma of the ascending colon is blood loss anemia. I report a case of long-standing polycythemia vera in a patient whose presenting symptom was small bowel obstruction, not blood loss anemia. It is my thesis that chronic blood loss in this patient was probably masked by the presence of polycythemia.

Report of a Case. —  A 59-year-old man had a family history of cancer and heart disease and a personal history that included (1) essential hypertension, (2) subarachnoid hemorrhage occurring during intercourse, (3) emphysema, (4) coronary bypass surgery in September 1975, (5) degenerative disc disease of C-4 to C-7, (6) cerebral vascular insufficiency with occasional transient ischemic attacks, (7) old right lower quadrant adhesions secondary to a perforated appendix, (8) Ascaris lumbricoides, and (9) polycythemia vera of more than 20 years' duration requiring 500-ml phlebotomies every two months until 1969.