Phlebotomy (the practice of bloodletting) is the main therapy used to treat polycythemia vera (PV). The purpose of bloodletting is to remove excess cellular elements from the blood, red blood cells and to improve blood circulation by lowering its viscosity. Phlebotomy is the most efficient method physicians have of lowering the hemoglobin and hematocrit levels to an acceptable level in patients; patients that have been diagnosed with PV are phlebotomized initially to decrease any risk of complications in further treatment.
Patients are typically phlebotomized once or twice a week to reduce hematocrit levels to below 45%. Elderly patients who have other cardiovascular issues or cerebral vascular complications should have the volume of blood removed replaced with a saline solution after each procedure. The presence of elevated platelet counts in the blood, which can sometimes be exacerbated by phlebotomy, is an indication that the phzsician use myelosuppressive agents to avoid thrombotic complications.
Once a patient’s haemoglobin and hematocrit levels have been reduced to an acceptable level, a maintenance program is established by using iron deficiency through continuous phelbotomies (the frequency of these will depend on red blood cell levels in the patient’s blood) or through a myelosuppression agent. The method used depends on the risk of secondary leukaemia occurring and the rate of thrombosis. Patients must be cautioned not to take iron supplements during these treatments.
The aim of treatment using phlebotomy for polycythemia are as follows:
• Reducing the risk of thrombosis
• Controlling or preventing bleeding
• Minimizing the risk of acute myeloid leukaemia
• Ameliorating the symptoms associated with the condition
There is no known cure for PV and treatment focuses on reducing the risk of complications in a patient and easing their symptoms.
Phlebotomy for polycythemia decreases a patient’s blood volume and reduces the number of excess blood cells with the frequency of the procedure depending on the severity of the condition. Where phlebotomy alone does not ameliorate the condition sufficiently, medications are prescribed that help reduce the number of red blood cells in the bloodstream; these can include medications that contain Hydroxyruea, Interferon alfa-2b and Ruxolitinib, among others.
A patient may also be prescribed medications to control any risk factors for heart disease, such as high blood pressure, high cholesterol levels and diabetes. Some patients are also advised to take a low dose of aspirin to reduce the risk of blood clots forming; this can also help reduce the burning pain in the feet or hands that patients with this condition sometimes experience.