FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TOO MUCH BLOOD THAT’S TOO "THICK" = POLYCYTHEMIA VERA

Question: I am a 77-year-old man diagnosed last May with polycythemia vera. I was experiencing shortness of breath and felt very tired most of the time. Since then I had a phlebotomy four different times. Before this treatment my hematocrit was 63 -- it’s now 46. I still get shortness of breath, but it’s not as bad as it was. Before I was diagnosed I was very active, walking two miles, dancing on weekends and exercising three to four times a week. Now I am very limited in all of those activities. What is the prognosis? Will I get better over time? Or, will I have to be satisfied with my condition?

Answer: You have given a very good description of the symptoms of polycythemia vera. This is a condition that strikes men more frequently than women and usually occurs in people over 50. In polycythemia vera, the bone marrow produces too many red blood cells, white blood cells and platelets. The cause is not well defined, but this condition has been associated -- in some cases -- with radiation exposure. There is also some evidence that it may run in families.

The primary symptoms of polycythemia vera are itching after bathing, shortness of breath, easy bruising, headaches, fatigue and blood clots. An enlarged, tender spleen is very common. Many people with polycythemia vera have a ruddy complexion, and elevated blood pressure. The primary cause of these symptoms is increased viscosity -- or “thickness” -- of the blood, as well as increased volume of blood. This diagnosis is easily made with a complete blood count (CBC), and a bone marrow biopsy may also be indicated in some cases.

Having too much blood can cause a number of medical problems, such as blood clots, heart attacks and strokes. Nosebleeds and intestinal bleeding are frequent complications of polycythemia vera. Gout is also a common complication of polycythemia vera and should be treated if it arises. While having too much blood that is too “thick” can predispose a person to blood clots, it can also make surgery riskier, as this increased blood often doesn’t clot well after surgery.

The good news is, this is a very treatable illness. The primary treatment is the one you mentioned -- phlebotomy. This procedure is simpler than its Latin name may imply. It simply involves removing blood from the body in a manner similar to what you may have experienced when you donated blood at the Red Cross. Generally, blood is removed when the hematocrit is elevated -- above 52 for males and 47 for females. These hematocrit figures, by the way, represent the percentage of the volume of a blood sample that’s occupied by cells (e.g., red and white blood cells). As you can see, your pretreatment 63 was elevated, but your current 46 is within the normal range for men. The frequency with which you will have to undergo future phlebotomies will be determined by how quickly your hematocrit returns to an elevated level.

There are also medications that can be used to decrease the bone marrow activity, but phlebotomy is the mainstay of treatment. People are able to live comfortably with this disorder, but some of the symptoms, such as fatigue and shortness of breath, may persist. Check with your physician first, but trying to regain your prediagnosis exercise and activity levels is probably worth the effort.

"Family Medicine" is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.