Query

[Mcrg]

E.T. Jak2 positive since 2018. On Hydroxicarbamide since autumn 2019. Bloods every three months and platelets reduced and more or less stable. This last six months, HCT has crept from 0.44 where it usually stays to 0.46.Dr suggested increasing HU to two tablets, four times a week and one tablet three times a week. (Previously the other way around) or venesection, which in the past made me very tired. I am iron deficiency all of the time anyway.

Which do you think would be the better option?

Thanks.

[hunter5582]

It is not clear why HCT is a concern at 46% if you have ET. It is within the normal range for a female and does not meet diagnostic criteria for PV (HCT>48% female). Keeping HCT below a certain level (HCT<45% male, HCT<42/43% female) is part of the treatment protocol for PV, but not for ET. Suggest reviewing your diagnosis/treatment goals and seeking an understanding of why it is an issue in your case.

If you already tolerate the current dose of HU, then increasing the weekly dose by one tab seems unlikely to cause a significant change in adverse effects. It would be a minimalistic intervention.

The purpose of venesection is to remove iron from the body to reduce erythropoiesis. It is supposed to make you more iron deficient without making you anemic. Chronic iron deficiency can have adverse effects like fatigue and loss of concentration.

If you want to drop the HCT level, then you would need to consider which risk you prefer to take - higher dose of HU vs venesection. There is not a clear answer to this. it is about your preferences.

All the best

[Mcrg in reply to hunter5582]

Thanks for replying