American Medical Association Family Medical Guide - American Medical Association [380]
Treatment
If you have polycythemia vera, you may be able to have treatment on an outpatient basis. The first goal of treatment is to lower the number of red cells in your blood, thereby reducing the thickness of your blood and your risk of developing blood clots or sludged blood, which can block blood flow. About a pint of blood is taken regularly from a vein in your arm. The frequency of blood removal (phlebotomy) is based on how long the number of red blood cells stays at a healthy level.
Drugs are sometimes used to control the overproduction of red blood cells. These drugs are usually taken by mouth for months to years, depending on how well they control blood cell production. Rarely, doctors recommend injections of radioactive phosphorus to reduce the number of red blood cells in the blood. Drugs are usually used only for people who cannot have their blood drawn regularly or for whom blood removal alone has not been effective in maintaining a healthy balance of red blood cells.
Aplastic Anemia
If you have aplastic anemia, your bone marrow’s production of blood cells decreases, causing a gradual or sudden reduction in the total number of cells in your bloodstream. In most cases of aplastic anemia, the cause cannot be identified. Sometimes it can be traced to exposure to radiation or a toxic substance such as benzene or to taking a particular medication. Many cases are thought to result from an overactive immune system that inhibits the ability of the bone marrow to produce blood cells. The condition may improve spontaneously or with treatment, but progressive failure of the bone marrow can also occur, making the condition worse.
Symptoms
Aplastic anemia has three main groups of symptoms. The decrease in the production of red blood cells causes the symptoms of iron deficiency anemia (see page 610). The decrease in the production of granulocytes, a type of infection-fighting white blood cell, makes you more susceptible to infections. The decrease in the production of platelets (cell fragments that enable blood to clot) causes the bleeding disorder thrombocytopenia (see page 620), which leads to easy bruising, red spots on the skin, and bleeding from the nose, mouth, and other areas. The bleeding may be severe enough to become life-threatening. If you have any of these symptoms, see your doctor right away.
Diagnosis
If you have symptoms of aplastic anemia, your doctor will probably ask you to have a blood test. If the test results show that you may have aplastic anemia, you may need to have a bone marrow aspiration and biopsy, in which a small amount of your bone marrow is removed through a needle and syringe and examined under a microscope. A bone marrow biopsy usually enables a doctor to make a definite diagnosis.
Treatment
If you have aplastic anemia that has resulted from taking a medication for another condition, your doctor will ask you to stop taking the medication and will prescribe a substitute drug. If there is a possibility of continuing exposure to a toxic substance at your workplace or at home, you need to eliminate the toxic substance from your environment; you may need to change jobs or move to another home.
Your doctor will probably treat the anemia and bleeding with blood transfusions and will treat infections with antibiotics, which are usually given intravenously (through a vein). If your condition doesn’t improve within a few weeks, your doctor will prescribe medication to stimulate your bone marrow to produce blood