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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The mainstay of therapy for polycythemia vera remains phlebotomy (blood letting). The goal of phlebotomy is to keep the hematocrit around 45% in men and 42% in women. Initially, it may be necessary to do phlebotomy every 2 to 3 days and remove 250 to 500 milliliters of blood each session. Once the goal is reached, maintenance phlebotomy can be performed less frequently.

A commonly recommended medication for the treatment of polycythemia is called hydroxyurea (Hydrea). This is especially advised in people at risk of clot formation. At age greater than 70, having both an elevated platelet count (thrombocytosis) greater than 1.5 million and cardiovascular disease makes the use of hydroxyurea more favorable. Hydroxyurea is also recommended in patients who are unable to tolerate phlebotomy.

Aspirin has also been used in treating polycythemia to lower the risk of clotting (thrombotic) events. Its use is generally avoided in those people with any bleeding history. Aspirin is usually used in conjunction with phlebotomy.

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