Q. A couple of my friends have

anemia and I've learned a lot about it through them. But I was recently

told that I have a condition called polycythemia, which means I have too

much blood. The doctor also said I will need to have blood drawn regularly.

Will I grow out of this or is there any treatment besides having blood

drawn?

A. Your friends have one of

the most common medical problems. As you have learned, someone with anemia

has too few red blood cells. And many people have abnormal red blood cells.

But a few people, like yourself, have too many.

Red blood cells are produced

in the bone marrow. And polycythemia vera is a blood disorder in which

the bone marrow produces too many blood cells, especially red blood cells.

The red cells are normal; there's just too many of them.

The average age at which polycythemia

vera is diagnosed is about 55, but it can develop as early as age 40.

An equal number of men and women are affected.

The excess number of cells

in the bloodstream lowers the amount of liquid in your blood vessels.

This makes the blood more viscous (thicker), so it flows less easily,

especially through smaller blood vessels.

Many symptoms of polycythemia

vera relate to the increased viscosity. Common complaints include headache,

dizziness, noises in the ear, blurred vision and fatigue. In most cases,

the spleen is enlarged because of the increased number of cells being

recycled there.

Polycythemia vera is suspected

when a routine blood test shows the hematocrit - the percentage of

red cells in the total blood volume - is elevated. But diagnosis

is not based on hematocrit alone. A blood test to estimate the total number

of red cells in the blood is needed to confirm the diagnosis.

Two similar disorders can cause

an increased hematocrit. One, polycythemia, occurs when the number of

red cells is normal but the liquid part of the blood is decreased.

Secondary polycythemia is a

disorder that occurs when the bone marrow produces more red blood cells

to make up for low levels of oxygen in the blood. This can occur with

smoking, lung and heart disease, or living at high altitudes.

The most serious complication,

and cause of most illness and death from polycythemia vera, is the danger

of blood clotting (thrombosis) in the arteries, both large and small.

Also, about 5 percent of people with this condition will get a form of

acute leukemia that is very hard to treat.

Secondary polycythemia canbe

improved with removal or treatment of the cause of low oxygen. But there

is no cure for polycythemia vera.

The treatment of choice is

phlebotomy; in which whole blood is removed in the same way blood is donated.

As you would expect, this blood cannot be used for transfusions. Phlebotomy

usually begins at the rate of a pint every week, and then tapers off as

blood cell counts gradually return to normal.

Drug treatment to suppress

production of blood cells, especially platelets that clot the blood, is

worth considering. But this form of treatment has had mixed success and

not many of the drugs are recommended for long-term use. The anticancer

drugs hydroxyurea, busulfan and alpha interferon have been shown to control

the disorder in some cases.

To decrease the risk of blood

clots, even with a higher number of platelets, you may want to try aspirin

or dipyridamole, but this needs to be balanced against the increased risk

of bleeding.

I'm sorry to report that

under the treatments known today, most people will not live more than

15 years after they are diagnosed with polycythemia vera. You need to

verify whether you have polycythemia vera or another type. Once that's

done, regardless of the type you have, make sure you are adhering strictly

to your treatment plan.

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