The most common treatment for polycythemia, particularly polycythemia vera, is phlebotomy.
Phlebotomy, which involves removing blood from the body, helps to reduce the red blood cell mass and lower the hematocrit (the percentage of red blood cells in the blood). This reduces the risk of blood clots and other complications associated with having too many red blood cells.
Here's a breakdown of polycythemia treatments, with phlebotomy at the forefront:
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Phlebotomy: This is often the first-line treatment. The goal is to lower and maintain the hematocrit level below 45%. Initially, phlebotomy may be performed regularly (e.g., once or twice a week) until the hematocrit is controlled. After that, it is done as needed to maintain the target hematocrit.
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Medications:
- Hydroxyurea: A chemotherapy drug that suppresses bone marrow production of blood cells. It is used when phlebotomy alone isn't sufficient to control red blood cell production, or for patients at higher risk of blood clots.
- Ruxolitinib: A Janus kinase (JAK) inhibitor used for patients with polycythemia vera who have an inadequate response to or are intolerant of hydroxyurea. It targets specific pathways involved in the excessive production of blood cells.
- Low-Dose Aspirin: Often prescribed to help prevent blood clots.
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Other Treatments:
- Hypouricemic Agents: Medications like allopurinol may be used to manage high uric acid levels, a common complication of polycythemia vera due to increased cell turnover.
- Management of Pruritus: Polycythemia vera can cause intense itching (pruritus). Antihistamines, phototherapy, or other medications may be used to manage this symptom.
The specific treatment plan will be determined by a doctor based on factors such as the patient's age, overall health, risk of blood clots, and symptoms. For example, pregnant women and neonates with polycythemia require specialized management.
In summary, while other treatments exist, phlebotomy is the most common initial treatment for polycythemia, aiming to reduce the red blood cell count and alleviate symptoms.
