What management strategy is recommended for symptomatic patients with polycythemia vera?

In the management of symptomatic patients with polycythemia vera, the most effective strategy is phlebotomy. Phlebotomy helps to reduce the elevated red blood cell mass, thereby decreasing blood viscosity and alleviating symptoms associated with this condition, such as headaches, dizziness, and a higher risk of thrombosis.

Phlebotomy is a straightforward and effective means of managing symptoms and improving the quality of life for patients with polycythemia vera. It helps to lower hematocrit levels to a target range, often improving symptoms and reducing the risk of related complications.

Other management strategies, such as immunosuppression, can be used in certain patients, particularly those with more severe or refractory disease. However, they do not address the immediate symptomatic relief and risks associated with elevated hematocrit and blood viscosity in symptomatic cases.

Aspirin may be used as an adjunct for its antithrombotic effects, primarily to reduce the risk of thrombotic events rather than to alleviate the primary symptoms of the disease. Bone marrow transplant is generally reserved for patients with severe disease or transformation to acute leukemia and is not a first-line treatment for managing symptoms in polycythemia vera. Therefore, phlebotomy is the most