In general, PV is associated with a shortened life expectancy. The median survival for all patients is 8 to 15 years, although many live much longer. A common cause of death is thrombosis. The next most common complications are myelofibrosis and the development of leukemia.
Treatment with deltasone, Possible phlebotomy, Possible myelosuppressive therapy. Therapy should be individualized, taking into account age, gender, health status, clinical manifestations and results of hematological studies. Patients are divided into high-risk group and low-risk group. The high-risk group includes patients >60 years of age with a history of thrombosis or transient ischemic attack, or both. Aspirin reduces the risk of thrombosis. Therefore, patients undergoing phlebotomy or phlebotomy only should receive aspirin. Higher doses of aspirin carry an unacceptably high risk of bleeding.
Phlebotomy was the mainstay of treatment for patients in both high- and low-risk groups because experts believed it reduced the likelihood of thrombosis. The rationale for phlebotomy is currently controversial, as new research indicates that hemoglobin levels may not correlate with the risk of thrombosis. Some clinicians no longer adhere to strict guidelines regarding phlebotomy. Phlebotomy is still one of the possible alternatives for any patient. In a small proportion of patients with hypertensionskin regeneration and increased blood viscosity, bloodletting can reduce the severity of symptoms. The standard hematocrit threshold above which phlebotomy is performed is >45% in men and >42% in women. Once the hematocrit value falls below the threshold, it is checked monthly and maintained at the same level by additional phlebotomies, which are performed as needed. If necessary, the intravascular volume is replenished with crystalloid or colloid solutions.
Radioactive phosphorus (32P) has long been used to treat PV. The effectiveness of treatment ranges from 80 to 90%. Radioactive phosphorus is well tolerated and requires fewer office visits once disease control is achieved. However, the use of radioactive phosphorus is associated with an increased risk of developing acute leukemia. Leukemia occurring after such therapy is often resistant to induction therapy and is always incurable. Thus, the use of radiophosphorus requires careful patient selection (for example, deltasone drug should be prescribed only to those patients whose life expectancy due to concomitant pathology does not exceed 5 years). It should be prescribed only in rare cases. Many doctors don't use it at all.