Confirm: repeat CBC ± peripheral smear; assess hydration/trend (could be hemoconcentration).
Urgent if unstable/symptomatic: escalate to senior.
Workup:
- Bloods: RFT/LFT/ferritin/iron studies/EPO level.
- Suspicious PV: JAK2 V617F, PBS, CALR MPL (need to consult hematologist) and bone marrow if needed.
- Other: renal USG (lesions), sleep study (OSA).
- Screening for OSA consider overnight oximetry.