NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

24 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 Secondary health problems ET can cause serious health conditions. Your doctor will assess you for these conditions. This is advised for all risk groups. Finding a health condition early may help prevent life-threatening events. Blood clots Your doctor will ask you about certain symptoms. Blood clots may cause leg pain, leg or arm swelling, and chest pain. You may have numbness or weakness on one side of your body. Your mental state may have suddenly changed. Your doctor may suggest getting an imaging test. Imaging tests make pictures of the insides of your body. They allow your doctor to see blood flow, blood clots, or both. Such tests include ultrasound, CT ( c omputed t omography), and MRI ( m agnetic r esonance i maging). Venography involves an injection of a dye followed by x-rays. Your doctor may prescribe an anticoagulant if you have a blood clot. Anticoagulants are also called blood thinners. LMWH ( l ow- m olecular- w eight h eparin) is a medicine that you inject into your skin at home. Dabigatran, rivaroxaban, apixaban, and edoxaban are newer types of oral anticoagulants. Warfarin is the most commonly used anticoagulant. These medications should be withheld if you will have surgery soon. If the clot is life threatening, you may receive plateletpheresis. This procedure withdraws your blood and removes platelets. Your platelet-reduced blood will then be returned to your body. Major bleeding Bleeding problems aren’t very common for ET. They are more likely if platelet counts are very high. Bleeding related to ET includes easy bruising, nosebleeds, or heavy menstrual periods. ET may also cause bleeding in your digestive track or blood in your urine. Your doctor will ask about symptoms and will perform a physical exam. You may see a liver or bowel expert if sudden bleeding occurs. You may receive plateletpheresis if bleeding is severe. Acquired VWD Your doctor will continue to assess for acquired VWD. Testing may be done if your spleen enlarges, platelet counts increase, if bleeding starts, or before having surgery. Coagulation tests are used to diagnose acquired VWD. These tests are described in Part 2. Cardiovascular risk factors Cardiovascular is a word that refers to the heart and blood vessels. There are cardiovascular factors that increase your chance for a blood clot. These risk factors include high blood pressure (hypertension), diabetes, and smoking. If you smoke, it’s important that you quit. If needed, your doctor will help you to reduce cardiovascular risk factors. Reducing risk factors is advised for all risk groups. Medications can help treat high blood pressure and diabetes. There are also medications that reduce cravings to smoke. Healthy living can reduce cardiovascular risk factors. Health experts can help you make and follow plans for healthy living. Such plans can focus on eating healthy foods, exercise, and taking medications as prescribed. You can also get help with a plan to quit smoking. Aspirin Most people with ET receive aspirin. It is an option for all risk groups. Your doctor may not prescribe aspirin if you have abnormal bleeding, acquired VWD, or a very high platelet count. It will increase your chance for bleeding. Aspirin is usually prescribed at a low dose. A low dose consists of 80 to 100 milligrams a day. 3 Essential thrombocythemia Initial treatment