How Is Polycythemia Vera Treated?

Polycythemia vera (PV) can't be cured. However, treatments can help control the disease and its complications. PV is treated with procedures, medicines, and other methods. You may need one or more treatments to manage the disease.

Goals of Treatment

The goals of treating PV are to control symptoms and reduce the risk of complications, especially heart attack and stroke. To do this, PV treatments reduce the number of red blood cells and the level of hemoglobin (an iron-rich protein) in your blood. This brings the thickness of your blood closer to normal.

Blood with normal thickness flows better through the blood vessels. This reduces the chance that blood clots will form and cause a heart attack or stroke.

Blood with normal thickness also ensures that your body gets enough oxygen. This can help reduce some of the signs and symptoms that PV causes, such as headaches, vision problems, and itching.

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

Treatments To Lower Red Blood Cell Levels

Phlebotomy

Phlebotomy (fle-BOT-o-me) is a procedure that removes some blood from your body. A needle is inserted into your vein, and your blood flows through an airtight tube into a sterile container or bag. The process is similar to the process of donating blood.

Phlebotomy reduces the number of red blood cells in your system and starts to bring your blood thickness closer to normal. Typically, a pint (1 unit) of blood is removed each week until your hematocrit level approaches normal. (Hematocrit is the measure of how much space red blood cells take up in your blood.)

You may need to have phlebotomy done every few months.

Medicines

Your doctor may prescribe medicines, such as hydroxyurea or interferon-alpha, to keep your bone marrow from making too many red blood cells.

Hydroxyurea is a medicine generally used to treat cancer. This medicine can reduce the number of red blood cells and platelets in your blood. As a result, this medicine helps improve your blood flow and bring the thickness of your blood closer to normal.

Interferon-alpha is a substance that your body normally produces. It also can be used to treat PV. Interferon-alpha can prompt your immune system to fight bone marrow cells that are making too many red blood cells. As a result, this treatment can help lower the number of red blood cells in your body and maintain blood flow and blood thickness that's close to normal.

Radiation Treatment

Radiation treatment can help suppress overactive bone marrow cells. This helps reduce the number of red blood cells in your blood. It also helps keep your blood flow and blood thickness close to normal.

However, radiation treatment can raise your risk for leukemia (blood cancer) and other blood diseases.

Treatments for Side Effects

Aspirin can relieve bone pain and burning feelings in your hands or feet that you may have as a result of PV. Aspirin also thins your blood, so it reduces the chance of blood clots forming.

Aspirin can have side effects, including bleeding in the stomach and intestines. For this reason, it's important to take aspirin only as your doctor recommends.

If your PV causes itching, your doctor may prescribe medicines to ease the discomfort. Your doctor also may prescribe ultraviolet light treatment to help relieve your itching.

Other ways to reduce itching include:

• Avoiding hot baths. Cooler water can limit the irritation to your skin.
• Gently patting yourself dry after bathing. Vigorous rubbing with a towel can irritate your skin.
• Taking starch baths. Add half a box of starch to a tub of lukewarm water. This can help soothe your skin.

Experimental Treatments

Researchers are studying other treatments for PV. An experimental treatment for itching involves taking low doses of selective serotonin reuptake inhibitors (SSRIs). This type of medicine is used to treat depression. In clinical trials, SSRIs reduced itching in people who had PV.

Imatinib mesylate is a medicine that's approved for treating leukemia. In clinical trials, it has helped reduce the need for phlebotomy in people who have PV. It also has helped reduce the size of enlarged spleens.

Researchers also are trying to develop a treatment that can block or limit the effects of an abnormal JAK2 gene. (A mutation, or change, in the JAK2 gene is the major cause of PV.)