First-line intervention to reduce hematocrit in PV?

First-line intervention to reduce hematocrit in PV?

• A. Therapeutic phlebotomy until Hct < 45%
• B. Splenectomy
• C. High-dose steroids
• D. Regular exercise only

Answer: (A)

In polycythemia vera, the main problem is an excess red cell mass that makes blood thick and prone to clotting. The fastest way to reduce this risk is to directly lower the red cell mass with therapeutic phlebotomy, removing blood and bringing the hematocrit down to below 45% (often aiming for about 42–45%, with adjustments by patient factors). This intervention rapidly decreases blood viscosity and thrombosis risk. Splenectomy isn’t a treatment for PV and adds surgical risks. High-dose steroids don’t address the elevated red cell mass and aren’t used to manage PV. Regular exercise alone won’t reliably reduce hematocrit or thrombosis risk in PV.

In polycythemia vera, the main problem is an excess red cell mass that makes blood thick and prone to clotting. The fastest way to reduce this risk is to directly lower the red cell mass with therapeutic phlebotomy, removing blood and bringing the hematocrit down to below 45% (often aiming for about 42–45%, with adjustments by patient factors). This intervention rapidly decreases blood viscosity and thrombosis risk.

Splenectomy isn’t a treatment for PV and adds surgical risks. High-dose steroids don’t address the elevated red cell mass and aren’t used to manage PV. Regular exercise alone won’t reliably reduce hematocrit or thrombosis risk in PV.