Dr Shammo: Polycythemia vera is a hematological malignancy that may become advanced in a subset of patients despite treatment with hydroxyurea and phlebotomy, resulting in ineffective disease control.

Narrator: Clinical characteristics of advanced PV may include hematocrit greater than or equal to 45% plus one additional risk factor despite treatment with hydroxyurea and phlebotomy. Specifically, clinical characteristics of advanced PV may include hematocrit greater than or equal to 45% plus elevated white blood cell count greater than 11 * 10⁹ per liter or burdensome disease-related symptoms such as fatigue, early satiety, inactivity, concentration problems, and itching.

Dr Shammo: Well, anytime you have a patient who has PV and has a hematocrit greater than 45%, you can correctly assume that the risk of thrombosis is definitely elevated. And the same could be said, although somewhat hampered by the retrospective nature of that finding, but I think it would be reasonable to also say that leukocytosis can also represent another factor for the increased risk of thrombosis. I think the symptom burden of patients who have PV have been largely underrepresented and underappreciated

Narrator: Actively monitor for hematocrit plus in your patients with polycythemia vera.