trying to differentiate polycythemia vera from smokers poly. in past not remarkable increases in platelets but a few times. Chronic leukocytosis and erytrocytosis. Recent 4/2 visit to hemo/onc said likey from smoking waiting on second opinion. last two months much weaker, er yesterday because of diff. headache upon waking at 5:30 am lasted through phenegran and fentenyl in ER at 8pm three bouts of petechiae in last six weeks (have had in past but significant increase) symptoms of enlarged spleen and possibly liver but not checked or confirmed. last year for previous year has zero ferretin, treated with iron infusions. post hysterectomy (endometrios heavy bleeding, incidently treated with lupron at age of 28 which cause two strokes and instead of chemical menopause being achieved bled for 60 days before stopping lupron then the strokes were misdiagnosed as panic attacked and confirmed years later) Have a long complicated medical history. I m female, 44 years old, a bit overweight. Have Osteoarthritis, Cervical Radiculopathy, Complicated Migraines, Vit D deficiency in addition to the chronic leukocytosis and erythrocytosis. Recent visit with hemo/onc because of the two last mentioned my primarys SPEP test showing a faint band so some further testing was done. Negative Jak2 a year ago, negative Phil. Chro more than a year ago... Labs and dates A year ago 3/14/2014 last normal RBC showed WBC 15.9 High (Range 4.0-12.0) RDW 18.1 High (Range 11-14) ANC 11.1 High (Rnge 1.4-7.9) Jump ahead last couple months 3/18/15 WBC 13.4 (range 4.0-12.0) HGB 17.2 (range 12-16) HCT 51.0 (Range 36.1-47) (sorry no differentials) 03/30/2015 WBC 17.2 (range 4-12) HGB 17.3 (range 12-16) HCT 52.7 (range 36.1-47) Here I had what was believed to be a dental infection, a fast growing lump on lower jaw with a decayed tooth well above it, that was ultimately extracted, however the lump/bone protrusion still there, never had pain with tooth, nonetheless was put on heavy antibiotic on 4/30 and on 4.2 more labs were done with the hemotoligist and read like this. would just over one day on antibiotic be cause for first normal WBC, albeit 9.9 Range high of 12, in years but abnormal again so IDK) 4/2/2015 Hemotologists labs WBC 9.9 (range 4-12) HGB 17.1 (range 12.5-16) HCT 49.9 (range 37-47) Basophil % 1.2 high (range 0.0-1.0) EPO 1.3 Low (Range 2.6-18.5) Immunoglobulin A 470 High (range 91-414) Immunoglobulin M 91 Normal (range is 40-230) Immunoglobulin G 1107 Normal (range is 700-1600) Notes: No M-spike 5/6/2015 ER CBC WBC 18.0 High (range 4.8-10.8) RBC 5.44 High (range 4.2-5.40) HGB 17.1 High (range 12-16) HCT 48.5 High (range 37-47) MCH 31.4 High (27-31.0) NE# 11.8 High (range 1.4-6.5) LY# 4.4 High (range 1.2-3.4) MO# 1.3 High (range .1-.6) EO# 0.3 High (range .0-.2) BA# 0.1 Normal (range .0-.2) incedentily the one normal WBC count on 4/2/15 showed elevated BA%) IG# 0.04 High (range .00-.02) I listed the abnomal results only but thought worth mentioning platelets have been okay elevated a couple times the past year and the normal results this past month went from normal 324 on 4/2/2015 range of 140-440 to ER visit yesterday of 372 with a range of 130-400 for their lab. So that s it. As you can see my concern as my symptoms are many and prominent the last couple months and waiting somewhat impatiently on second opinion. My biggest concern is a transformation perhaps if primary PV into a leukemia. Very much appreciate your thoughts. especially on the most recent labs of yesterday. And if EPO is low in a smoker (pack a day) with an Erythrocytosis wouldn t that point towards a primary marrow disease rather than being reactive to smoking?