Management practices, challenges and approaches to clinical complications of polycythemia Vera in tertiary healthcare institutions in Nigeria: A narrative review

Background: Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by JAK2 V617F gene mutations mutation, which is present in about 95- 97% of patients with this disease.. Despite advances in understanding PV pathophysiology and development of evidence-based management guidelines, its management in Nigerian tertiary hospitals remains constrained by diagnostic, infrastructural, and systemic challenges. Objective: This narrative review synthesizes existing literature on PV management practices, challenges, and clinical complications in Nigerian tertiary healthcare institutions to identify gaps in current practices and inform future improvements. Theoretical Framework: The review is anchored on three complementary theoretical perspectives: the Theory of Planned Behaviour (1991), which explains behavioral determinants of clinical decision-making; Donabedian's Model of Healthcare Quality (1980), which evaluates healthcare delivery through structure, process, and outcome dimensions; and Open Systems Theory (1968), which conceptualizes healthcare institutions as dynamic systems interacting with their external environment. Methods: A comprehensive review of published literature from 2020-2025 examining PV management in tertiary healthcare settings was conducted, focusing on epidemiology, current management practices, clinical complications, healthcare professional challenges, and strategic approaches to care delivery. Results: Limited epidemiological data from Nigeria and West Africa indicate lower reported prevalence and younger age at presentation compared to global patterns. Current management practices include phlebotomy as cornerstone therapy, low-dose aspirin for thrombotic prevention, and cytoreductive therapy for high-risk patients. However, implementation faces significant barriers including limited access to JAK2 mutation testing, inconsistent availability of therapeutic agents, and varying expertise levels among providers. Thrombotic events represent the most serious complications, with 20-year rates of 26% for thrombosis, 16% for fibrotic transformation, and 4% for leukemic transformation. Healthcare professionals encounter challenges including diagnostic delays, treatment resistance management, practice variation, and difficulties maintaining current knowledge amid rapidly evolving therapeutic options. Conclusion: Managing PV in Nigerian tertiary hospitals requires strengthening diagnostic infrastructure, developing standardized treatment protocols, and expanding professional training. While providers demonstrate adaptive capabilities through experience-based approaches, systematic improvements in resource availability, guideline implementation, and multidisciplinary collaboration are essential for achieving optimal patient outcomes and reducing complications in resource-limited settings.