NCCN Guidelines for Patients® | Myeloproliferative Neoplasms
36 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 4 Polycythemia vera Initial treatment Phlebotomy A goal of treatment is to reduce hematocrit. In general, hematocrit should be below 45%. For women, a target of below 42% is often used. Lowering hematocrit will likely reduce blood thickness. As a result, your chance for getting blood clots will decrease. You may also have fewer headaches, less itchiness, and fewer vision problems. Phlebotomy is key to treating PV. It’s a procedure that is likely to reduce hematocrit. It is much like donating blood. Your blood will be withdrawn with a needle inserted into a vein. See Figure 9 . Your pulse and blood pressure may be watched as your blood is removed. You may feel dizzy during or right after the procedure. Phlebotomy produces iron deficiency to control PV. Thus, iron supplements should not be taken. How often phlebotomy is needed differs between people. Some people need it every other week. If your hematocrit is high, you may need it once or twice a week. Often 500 mL of blood is withdrawn. This should reduce hematocrit by 3 points. Surgery You may need surgery while being treated for PV. Hematocrit should be below 45% for 3 months prior to surgery. You may need more phlebotomy visits to maintain hematocrit of <45%. Figure 9 Phlebotomy Phlebotomy is a procedure that is commonly used to control PV. It involves withdrawing your blood much like when donating blood. The goal is to reduce your hematocrit. This will reduce your chance for getting blood clots. Phlebotomy may also reduce symptoms.