Polycythemia Vera: 2025 Guidance
Polycythemia vera is a blood disorder causing excess red cells and clot risk, managed by phlebotomy, aspirin, and cytoreductive therapy when needed.
Overview
Polycythemia vera (PV) is a chronic blood disorder in which the marrow makes too many red blood cells. It belongs to a group of diseases called myeloproliferative neoplasms.
Most cases carry a JAK2 gene mutation. Without treatment, PV can lead to clotting, bleeding, and, rarely, progression to scarring or leukemia.
Symptoms And Risks
Common signs include headache, itching after a warm bath, redness, and an enlarged spleen. The greatest danger is blood clots in arteries or veins.
Risk of clotting rises with age over 60 or any prior clot. Controlling reversible risks such as smoking and blood pressure is essential.
Diagnosis
Diagnosis uses blood counts showing high hemoglobin or hematocrit, a bone marrow exam, and JAK2 mutation testing. Low blood erythropoietin supports the finding.
Doctors first exclude secondary causes such as low oxygen, kidney tumors, or dehydration before confirming PV.
Treatment Goals
The main aim is preventing clots and controlling symptoms while keeping hematocrit below 45%. Most patients take low-dose aspirin and undergo phlebotomy.
Higher-risk patients may need medicine to lower blood cell production. Regular monitoring every few months tracks response and safety.
