Polycythemia Vera: Maintaining Hematocrit ≤ 45% for Better Outcomes

Aniket Bankar, MD, Princess Margaret Cancer Center in Toronto, Canada, discusses some of the current challenges that have been seen in managing patients with polycythemia vera (PV).

Managing hematocrit levels is critical for patients with conditions like PV that require phlebotomy or cytoreductive treatments, such as hydroxyurea or interferon. According to Bankar, hematocrit, the proportion of blood volume occupied by red blood cells, must be maintained at or below 45% to minimize risks. However, this control is particularly challenging for low-risk patients who rely on phlebotomies.

Regular monitoring is necessary, as suboptimal hematocrit management requires more frequent phlebotomies. Studies have indicated that higher hematocrit levels are linked with an increased risk of thrombosis and other symptoms, showing that maintaining appropriate hematocrit levels not only alleviates symptoms but also reduces the risk of potentially life-threatening events for these patients.

To optimize outcomes, healthcare providers must ensure vigilant monitoring and individualized treatment plans. This approach will help to maintain hematocrit within the desired range, minimize the need for frequent phlebotomies, and address iron deficiency promptly. Overall, this will enhance patients’ health and reduce the risk of severe complications.

Here, Bankar further discusses the importance of managing hematocrit in PV.

Transcription:

0:09 | The current challenges lie in making sure that their hematocrit is controlled [maintained ≤ 45%], irrespective of when they are visiting their phlebotomist, especially those low-risk patients who are managed with phlebotomies, or patients who are receiving cytoreductive treatment, including hydroxyurea and/or interferon.

0:38 | Many patients continue to need phlebotomies because of suboptimal hematocrit control. And when phlebotomies are frequently required, these patients lose iron and become iron-deficient, which can lead to worsening of symptoms. Some studies have also shown that when you have higher hematocrit levels, that can also increase the risk of developing symptoms and thrombosis.