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Treating Polycythemia Vera (PV) With Phlebotomy

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Published on August 16, 2016

What is phlebotomy, and how will it help my polycythemia vera (PV)?  Patient Power Founder and Host, Andrew Schorr,, discusses this cornerstone treatment with Dr. Mark Heaney of Columbia University Medical Center.  Dr. Heaney explains phlebotomy, and the reason it’s the cornerstone of PV treatment. low-dose aspirin and cytoreductive therapies, hydroxyurea (Hydrea) and ruxolitinib (Jakafi), are also explained.

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Transcript | Treating Polycythemia Vera (PV) With Phlebotomy

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Dr. Heaney, let’s go onto PV. So some of the same drugs but not only. And I know that Jakafi, ruxolitinib, not that long ago was approved for some people with PV so help us understand where that comes in.

And interferon again, and then we’ll maybe talk separately about phlebotomy, not as a drug therapy.

Dr. Heaney:         

Actually, the phlebotomy is for the cornerstone of treatment. The goal in polycythemia vera is to keep the hematocrit below 45. And so the simplest way of doing that is with phlebotomy, so that’s usually the first method that we use in patients. A complementary method, because patients with polycythemia vera are at increased risk of blood clots, is also low-dose aspirin therapy. But the primary risk of polycythemia vera is the same as ET, and that’s the risk of blood clots.

We know that patients in whom we can keep the hematocrit less than 45 have a lower risk than patients whose hematocrits are allowed to be higher than that. The challenge to phlebotomy, the reason why those other drugs are on the list, is that sometimes phlebotomy isn’t enough to control the counts.

Andrew Schorr:                  

Let’s just be clear on what phlebotomy is. Quite frankly, for some people who have had it, I think of going back to medieval times, blood letting. But basically, you go to the clinic, and you’re drawing blood or cells out, right?

Dr. Heaney:         

Right. So we don’t have enough leeches to take all the blood that we would need to control the disease.

Andrew Schorr:                  

It’s like the reverse of going to the Red Cross blood bank and giving blood—you’re taking blood.

Dr. Heaney:         

That’s right. The goal is actually to make patients a little bit iron deficient. The challenge, though, is that you always need to have some iron in the body. If you make patients too iron deficient, then you can cause other problems. So if the disease for each patient is such that you can’t control the hematocrit just with phlebotomy, then you need to employ something else that’s a cytoreductive therapy.

Andrew Schorr:                  

We mentioned those—the hydroxyurea (Hydrea), etc. Okay. But now Jakafi or ruxolitinib comes into play, not used universally in PV, but where does that have a place?

Dr. Heaney:         

Right now it’s FDA approved for patients who either have too many side effects from hydroxyurea or where the hydroxyurea is not working effectively to control the blood counts.

Andrew Schorr:                  

Okay. So you make an assessment, and then for that subset of patients it would be an approved medication?

Dr. Heaney:                                                               

That’s right.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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