Optimizing Phlebotomy Strategies: Frequency and Clinical Considerations

Summary for Physicians: Phlebotomy Frequency as a Marker for Escalation in PV Management

In PV, the frequency of phlebotomy can serve as a practical and objective indicator of disease activity and the need for treatment escalation beyond phlebotomy and aspirin.

Key Considerations:

• High Phlebotomy Demand:
  A need for more than 4 to 6 phlebotomies per year to maintain hematocrit <45% often signals inadequate disease control with phlebotomy alone. This threshold is commonly used to consider initiating cytoreductive therapy.
• Associated Concerns:
• Progressive iron deficiency (leading to fatigue, cognitive dysfunction, or other symptoms)

• Worsening symptom burden despite hematocrit control

• Poor tolerance or logistical burden of frequent procedures

• Rising leukocyte or platelet counts alongside high phlebotomy needs

Implications for Management:

A persistently high need for phlebotomy suggests a more active disease state and may warrant the introduction of cytoreductive therapy to better control hematopoiesis, reduce symptom burden, and potentially decrease thrombotic risk.