NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

33 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Initial treatment There are many other common symptoms. You may have headaches, dizziness, vision changes, and fatigue. Your abdomen may hurt. You may quickly feel full when eating. PV is diagnosed based on certain standards. First, the mass of red blood cells, hematocrit, or hemoglobin must remain high. A high red blood cell mass is called erythrocytosis. Second, there must be too many cells in your bone marrow. Third, the blood cells must have a common JAK2 mutation or your EPO levels are usually low. Initial treatment There are two treatment goals for PV. The first is to reduce your chance for serious related health conditions. This is mostly achieved by reducing red blood cell counts. The second goal is to relieve symptoms. Most people have symptoms when they first learn they have PV. Younger women with PV may want to have a baby. Before getting pregnant, it may help to meet with a high-risk obstetrician. This doctor can tell you what health care you will need during pregnancy. Guide 5 lists the treatment options for PV. Options are based on your chance for having a blood clot. Some blood clots can cause a heart attack, stroke, or serious breathing problems. If pregnant, blood clots may harm you and your baby. Your doctor will assess whether you are at low or high risk. † † Low risk describes people who are younger than 60 years of age and never had a blood clot. † † High risk describes people who are 60 years of age and older or have had a blood clot. Guide 5. Initial PV treatment by risk group What are the options? Low High • Assess for secondary health problems • Reduce cardiovascular risk factors (ie, high blood pressure, diabetes, smoking) • Aspirin for vascular symptoms • Phlebotomy to control hematocrit level • Cytoreductive treatment (ie, hydroxyurea, interferons)