Phlebotomies after age 70?

[Innessant]

I am male aged 67 with PV .Diagnosed 10 years ago. Treatment plan includes 8 years of phlebotomies (~4 a year) and aspirin. In last two years I am additionally on Hydroxyurea (HU) . Otherwise I exercise frequently, have good BMI am fit and and feel very well.My blood counts go up and down but I watch this and manage it. My Haematologist recently mentioned that over 70 years old it may be difficult to keep doing phlebotomies. For me they work fine and I personally prefer the simplicity and logic of bloodletting versus more medications. Does anyone have any views or experience on this matter?

[ainslie]

I’ve never heard of that, if in doubt get a second opinion but I would put money on it being incorrect in your case

[Innessant in reply to ainslie]

Thanks for your comment

[EastYorkshireman]

I am 75, with pv diagnosed almost three years ago. My specialist nurse on two occasions after fbc rang to increase my hydrea which I resisted ( I already take 500 mcg 5 days and 1 mg 2 days) On the first occasion when I asked for phlebotomy instead, she told me that it would a one off. However, the next time she called 9 months later I was able to talk her into another phlebotomy session instead of increasing my hydrea medication. I really don’t want to take more medication unless I really have to and like you I find the phlebotomy sessions simple and so far from my point of view better than taking more drugs. Good luck for the future.

[ainslie in reply to EastYorkshireman]

Your quite right, some docs prefer to dish out more Hydroxy , it’s cheaper and less hassle for the hospital and doc than venisecting but not necessarily the best thing for the patient which of course should be the priority

[Innessant in reply to EastYorkshireman]

Many thanks for your reply . Sounds like it is working well for you. obviously you dont play a game of football right after a session. I find the Hydroxyurea to be without any side effects in my case. Others seem to have problems and it is they who often go online about it. In general people stay quiet when medication works fine.

[mark382]

I have heard of this. I think I heard it was 60, but that was to go on medication. I was diagnosed PV 16 years ago. Clinics every 3 months. Venesection about 5 times a year and on aspirin. Other than medication being mentioned when originally diagnosed, it's never been mentioned since. Looking at side affects of drugs I'm keeping stum

[Innessant in reply to mark382]

Thanks for sharing this positive news which is encouraging for all of us.

[hunter5582]

I have never heard of an age limit on using venesections to supplement cytoreductive medications. Balancing a cytoreductive medication with occasional venesections to maintain control of erythrocytosis seems like a very logical choice if that is your preference. Increasing the dose of hydroxycarbamide would increase the risk of adverse effects. It is worth noting, however, that venesection-induced iron deficiency can also have adverse effects even when you are not anemic. That happened to me.

These days I use a low dose of Besremi for cytoreduction and an occasional venesection, about 1x/year. I feel better than ever with this approach. I am age 69 and together with my MPN care team plan to continue this approach for as long as it works. There is no evidence in the literature that I am aware of that indicates any need to change this plan.

[Innessant in reply to hunter5582]

thanks Hunter for your reply. Good point about the possibility of iron deficiency. Although that sounds relatively easy to manage. I’m encouraged by your comments and others. Cytoreductive medications are wonderful, but I also see them as useful in tandem with the venesections .

[EPguy]

Phlebotomies can be a concern when they cause iron in the system gets out of balance. PV alone can cause this too. As noted here :

"Therapeutic phlebotomy is one of the causes of iron deficiency" and "Patients under 60 years of age with a low risk of thrombosis are often treated with phlebotomy alone".

Your Dr may be just reflexively following an age limit, or may have found uncontrolled iron imbalance.

tandfonline.com/doi/full/10...

Has your Dr done an iron study? This is a routine blood test. If all is ok and your not having fatigue or other discomforts then you are reasonable to ask what is it about age 70?

[Innessant in reply to EPguy]

Thanks. Again very good points. So far so good and no real fatigue or other problems at the moment. It’s amazing how much blood the body produces … my other thought is that giving the spleen a break from too much hard work absorbing old blood cells must help.

[Innessant in reply to EPguy]

Thanks for your helpful input. Agree it is a number only without other inputs.