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| __NOTOC__ | | __NOTOC__ |
| {{Polycythemia}} | | {{Polycythemia}} |
| {{CMG}} {{AE}}{{Debduti}} | | {{CMG}} {{AE}}{{Debduti}}{{ZO}} |
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| ==Overview==
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| *Phlebotomy: the backbone of therapy, treatment with phlebotomy alone associated with a longer median survival compared to the use of chlorambucil or radioactive phosphorous based on a trial conducted by PV study group. Repeated phlebotomies help in cytoreduction and reduce hyper-viscosity in addition to induce a state of iron-deficiency which can help retard red-cell proliferation. Weekly sessions are conducted, by remove 500ml of blood until a target hematocrit of under 45% is obtained. This can lower rates of cardiovascular deaths and major thrombotic episodes in patients kept under this threshold based on a trial conducted in Italy. For secondary polycythemias, phlebotomy is usually reserved for the following conditions:
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| **Chronic lung diseases
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| **Cyanotic heart diseases
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| **Post-renal transplant patients with hypertension and erythrocytosis, not responding to optimal doses of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARB) <ref name="pmid24120605">{{cite journal| author=Assi TB, Baz E| title=Current applications of therapeutic phlebotomy. | journal=Blood Transfus | year= 2014 | volume= 12 Suppl 1 | issue= | pages= s75-83 | pmid=24120605 | doi=10.2450/2013.0299-12 | pmc=3934278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24120605 }} </ref> <ref name="pmid30252337">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=30252337 | doi= | pmc= | url= }} </ref>
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| ==Indications== | | ==Indications== |
| | | Surgical intervention is not recommended for the management of polycythemia. |
| *Phlebotomy: the backbone of therapy, treatment with phlebotomy alone associated with a longer median survival compared to the use of chlorambucil or radioactive phosphorous based on a trial conducted by PV study group. Repeated phlebotomies help in cytoreduction and reduce hyper-viscosity in addition to induce a state of iron-deficiency which can help retard red-cell proliferation. Weekly sessions are conducted, by remove 500ml of blood until a target hematocrit of under 45% is obtained. This can lower rates of cardiovascular deaths and major thrombotic episodes in patients kept under this threshold based on a trial conducted in Italy.
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| *For secondary polycythemias, phlebotomy is usually reserved for the following conditions:
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| **Chronic lung diseases
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| **Cyanotic heart diseases
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| **Post-renal transplant patients with hypertension and erythrocytosis, not responding to optimal doses of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARB) <ref name="pmid24120605">{{cite journal| author=Assi TB, Baz E| title=Current applications of therapeutic phlebotomy. | journal=Blood Transfus | year= 2014 | volume= 12 Suppl 1 | issue= | pages= s75-83 | pmid=24120605 | doi=10.2450/2013.0299-12 | pmc=3934278 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24120605 }} </ref> <ref name="pmid30252337">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=30252337 | doi= | pmc= | url= }} </ref>
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| ==Surgery==
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| *Phlebotomy: the backbone of therapy, treatment with phlebotomy alone associated with a longer median survival compared to the use of chlorambucil or radioactive phosphorous based on a trial conducted by PV study group.
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| ==Contraindications== | | ==Contraindications== |