Polycythemia vera (patient information)
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Turky Alkathery, M.D. [2]
Overview
Polycythemia vera is a bone marrow disease that leads to an abnormal increase in the number of blood cells. The red blood cells are mostly affected.
What are the symptoms of Polycythemia vera?
Symptoms may include any of the following:
- Trouble breathing when lying down
- Dizziness
- Excess bleeding
- Full feeling in the left upper abdomen (due to enlarged spleen)
- Headache
- Itchiness, especially after a warm bath
- Red skin coloring, especially of the face
- Shortness of breath
- Symptoms of blood clots in veins near the skin surface (phlebitis)
Other symptoms that may occur with this disease:
- Bluish skin color
- Fatigue
- Red skin spots
- Vision problems
What causes Polycythemia vera?
- Polycythemia vera is a disorder of the bone marrow. It mainly causes too many red blood cells to be produced. The numbers of white blood cells and platelets may also be higher than normal.
- This is a rare disorder that occurs more often in men than in women. It is not usually seen in people under age 40. The problem is often linked to a gene defect called JAK2V617F. The cause of this gene defect is unknown.
When to seek urgent medical care?
Call your health care provider if symptoms of polycythemia vera develop.
Diagnosis
The health care provider will perform a physical exam. You may also have the following tests:
- Bone marrow biopsy
- Complete blood count with differential
- Comprehensive metabolic panel
- Erythropoietin level
- Genetic test for the JAK2V617F mutation
- Oxygen saturation of the blood
- Red blood cell mass
- Vitamin B12 level
This disease may also affect the results of the following tests:
- ESR
- Lactate dehydrogenase (LDH)
- Leukocyte alkaline phosphatase
- Platelet aggregation test
- Serum uric acid
Treatment options
- The goal of treatment is to reduce the thickness of the blood and prevent bleeding and clotting problems.
- A method called phlebotomy is used to decrease blood thickness. One unit of blood (about 1 pint) is removed each week until the number of red blood cells drops. The treatment is continued as needed.
- Medicines that may be used include:
- Hydroxyurea to reduce the number of red blood cells made by the bone marrow. This drug may be used when the numbers of other blood cell types are also high.
- Interferon to lower blood counts.
- Anagrelide to lower platelet counts
- Ruxolitinib (Jakafi) to reduce the number of red blood cells and reduce an enlarged spleen. This drug is prescribed when hydroxyurea and other treatments have failed.
- Taking aspirin to reduce the risk of blood clots may be an option for some people. But, aspirin increase the risk of stomach bleeding.
- Ultraviolet-B light therapy can reduce the severe itching some people experience.
Where to find medical care for Polycythemia vera?
Directions to Hospitals Treating Polycythemia vera
What to expect (Outlook/Prognosis)?
The disease usually develops slowly. Most people do not have symptoms related to the disease at the time of diagnosis. The condition is often diagnosed before severe symptoms occur.
Possible complications
Complications may include:
- Acute myelogenous leukemia (AML)
- Bleeding from the stomach or other parts of the intestinal tract
- Gout
- Heart failure
- Myelofibrosis
- Thrombosis (blood clotting, which can cause a stroke, heart attack, or other body damage)