How Is Polycythemia Vera Treated?

Your doctor may treat your polycythemia vera (PV) with a number of methods, either separate or in combination. Your treatment options may include phlebotomy (fle-BOT-o-me), medicines, or biological therapy.

Goals of Treatment

PV cannot be cured. The goals of treating PV are to control your symptoms and reduce the risk of complications, especially stroke or heart attack, caused by thickened blood and blood clots. This is done by reducing the number of red blood cells and hemoglobin in your blood toward normal levels. Reducing the number of red blood cells and hemoglobin brings the thickness of your blood closer to normal levels. Blood with normal thickness flows more easily through the arteries. This reduces the chances that blood clots will form that could cause you to have a stroke or heart attack. Blood with normal thickness delivers oxygen more efficiently to all parts of your body. This can help reduce some of the signs and symptoms PV causes, such as headaches, vision problems, and itching.

Studies show that treatment of PV greatly improves your chances of living longer.

Specific Types of Treatment

Phlebotomy

In phlebotomy, your doctor or technician removes some of your blood from a vein (similar to what is done when you donate blood). A needle is inserted into your vein, and your blood flows through an airtight tube into a sterile container or bag. This reduces the number of red blood cells in your system and begins the process of bringing your blood thickness closer to normal levels. Typically, a pint (1 unit) of blood is removed each week until your hematocrit (the measure of what percentage of a tube of blood consists of red blood cells) approaches a normal level. Then, you may continue to have phlebotomy performed every few months as needed.

Medicines

Your doctor may prescribe medicines to keep your bone marrow from making too many red blood cells. You may take hydroxyurea (hi-DROK-se-u-RE-ah), a chemotherapy medicine, to reduce the numbers of red blood cells and platelets in your blood. By limiting or reducing the number of red blood cells in your blood, this medicine helps bring your blood thickness and blood flow closer to normal levels.

Your doctor may advise you to take aspirin to relieve bone pain and the burning sensation in hands or feet that you may experience as a result of PV. Aspirin also reduces the chance of blood clots.

Biological Therapy (Immunotherapy)

This form of treatment uses substances made naturally in the body to stimulate your immune response against overproduction of red blood cells. Your doctor may prescribe substances that your body normally produces, like interferon-alpha, if you have PV. These substances reduce the overproduction of blood cells by the bone marrow. This helps keep your blood thickness and blood flow closer to normal levels, reduces the chances of blood clots, and may reduce some of the signs and symptoms of PV.

Other Types of Treatment

If you have itching as a result of PV, your doctor may prescribe a number of prescription medicines to ease the discomfort you feel. These include cholestyramine, cyproheptadine, cimetidine, or psoralen. Your doctor also may prescribe ultraviolet light treatment and antihistamines to help relieve your itching.

Your doctor may prescribe allopurinol if the level of uric acid in your blood is higher than normal.

Your doctor may decide to treat you with radioactive phosphorus (P³²) to suppress overactive bone marrow cells. This helps reduce the number of red blood cells in your blood, and keeps your blood's thickness and flow closer to normal levels.