PV is the example of classic MPNs which predominated with erythroid and megakaryocyte hyperplasia.[4] According to the WHO diagnosis of PV is made from all 3 major or first major with 1 minor criteria (major criteria: 1) Hb >16.5 g/L for men and Hb >16 g/L for women or hematocrit of >49% for men and 48% for women; hypercellularity of bone marrow with accelerated growth of trilineage; and mutation of the JAK2 gene.[1] Our patient had 2 major criteria and evidence of a coronary occlusion on this current presentation. The gene discussed is GSTM1; the disease is acquired polycythemia vera.