Abstract
<h3>CASE PRESENTATION</h3> —Peter White, Jr, MD A 64-YEAR-OLD retired truck driver was brought to The Johns Hopkins Hospital after a transient episode of unresponsiveness. Ten days before admission, when he entered another hospital for treatment of acute polyarticular gout, he appeared plethoric and had an enlarged spleen. The hematocrit was 0.71, red blood cell volume was 81 mL/kg (normal, 25 to 35 mL/kg), and plasma volume was 33 mL/kg (normal, 30 to 45 mL/kg). Bone marrow was hypercellular without fibrosis. He was treated for gout and polycythemia vera. Within a week 1200 mL of blood was withdrawn and he was discharged. On the following day, he was found to be unresponsive, with twitching movements of his hands and feet. The episode resolved within a few minutes, but he was promptly brought to the emergency department, where results of neurological examination and a cranial computed tomographic scan were normal. The patient
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