NCCN Guidelines for Patients® | Myeloproliferative Neoplasms
34 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Initial treatment Secondary health problems PV can cause serious health conditions. Your doctor will assess you for these conditions. This is advised for both risk groups. Finding a health condition early may help prevent life-threatening events. Blood clots Blood clotting is common in PV. 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 your platelets are very high, you may receive plateletpheresis. This procedure withdraws your blood and removes platelets. Your platelet-reduced blood will then be returned to your body. Bleeding Bleeding is common in PV but often isn’t severe. Bleeding related to PV includes easy bruising, nosebleeds, or heavy menstrual periods. PV may also cause bleeding in your digestive track or blood in your urine. Your doctor will ask about these symptoms and will perform a physical exam. You may see a liver or bowel expert if sudden bleeding occurs. 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. Drink plenty of water It is important that you drink plenty of water. Avoid dehydration because it makes blood more thick (viscous). Remember, the more active you are the more dehydrated you will become.