Canterbury DHB

Context

Treatment

The short-term goals of treating PV are to alleviate any symptoms and minimise vascular risk with cytoreduction and antiplatelet therapy, as follows:

  1. Venesection to maintain haematocrit <0.45.
  2. Low-dose aspirin (unless contraindicated or platelet count >1500).
  3. Control symptoms of pruritus (antihistamines, SSRI), erythromelalgia (aspirin), fatigue (exercise).
  4. Manage reversible thrombotic risk factors aggressively (e.g. smoking, hypertension, hypercholesterolemia, obesity).
  5. Higher risk patients (age >60, vascular risk factors, thrombosis, uncontrolled thrombocytosis >1500 or marked neutrophilia) may also need medication. At this stage, hydroxyurea is recommended as the first-line option. (Low-risk patients are defined as <60 years with no history of vascular events, and usually do not require cytoreductive medications.)

Note – manage female patients who wish to become pregnant with venesection alone where possible, but interferon can be added if necessary (as per CML).

See the polycythemia vera treatment algorithm by Tefferi A, et al. (2018)6, figure 1 page 3.

About this Canterbury DHB document (8840):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

August 2018

Next Review:

April 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 8840