• Venesection (or phlebotomy)
  
  Patients with polycythaemia vera are often treated with venesection, which means removing blood from the body. Patients receive regular venesections until they reach a satisfactory blood thickness (or haematocrit) level. Venesection is done just like a blood donation - a doctor or nurse inserts a needle into your vein and collects some blood. The target blood thickness (haematocrit) depends on the disease, risk factors, tolerance of the procedure and any previous complications.
  

• Hydroxycarbamide
  
  Hydroxycarbamide is a drug that interferes with cell metabolism. It is a daily treatment and blood counts need monitoring every two to three months.
  
  The side effects include some darkening of skin, mouth and leg ulcers, and sometimes stomach problems. Hydroxycarbamide can damage cells and may affect fertility. Women who are pregnant or trying to conceive should not use it. There is a small chance that hydroxycarbamide may increase the risk of acute leukaemia.
  

• Interferon alpha
  
  Interferon alpha is a natural agent that reduces the production of bone marrow cells. We use it in some MPD patients who want to preserve fertility and we can use it in pregnant women. We usually give interferon alpha by injection three times a week, but sometimes more or less frequently. The side effects are mainly flu-like symptoms (which can be addressed with paraceutemol), hair loss, depression, liver and thyroid changes. Interferon does not increase the risk of leukaemia.
  

• Anagrelide
  
  Anagrelide is a drug that lowers the platelet count by reducing the size of the platelet-producing cells called megakaryocytes. It should not affect fertility or increase the risk of developing acute leukaemia. Anagrelide can have side effects including headache, diarrhoea, palpitations and fluid retention. It is not suitable for pregnancy, and we use it with caution in heart disease. A recent study (Primary thrombocythaemia 1) reports that this drug used in conjunction with aspirin is not as effective as hydroxycarbamide plus aspirin at preventing some complications in ET at least.
  

• Melphalan, busulphan and phosphorous
  
  Melphalan, busulphan or radioactive phosphorous were the main therapies used to treat ET in the past. However, all of these are capable causing infertility and damaging the bone marrow, and are known to increase the risk of developing acute leukaemia. Haematologists still use both busulphan and phosphorous to treat MPD when other drugs are not working, when there are side effects, or when it is difficult for patients to take hydroxycarbamide tablets.
  

• Glivec (Imatinib or STI 571)
  
  Glivec is a drug which has produced very dramatic results in leukaemia patients. It is designed to block the action of an abnormal enzyme formed by genetic changes found in leukaemia. There is little information about whether Glivec controls this disease over a period of many years. Glivec is taken as a tablet; the side effects include low blood counts, rashes, and swelling, especially over the eyes. It is unlikely to cause leukaemia in the long term but is not safe for use in pregnancy.

• Other treatments
  
  In addition to using drugs or venesection, we treat a number of patients with aspirin to reduce the likelihood of complications. Aspirin may increase bleeding in patients with PV, especially in the digestive system. This is unlikely to be the case if the blood count is well controlled and the patient has no pre-existing ulcer or bleeding history. Warfarin and heparin are blood-thinning drugs used to treat or prevent a blood clot, and heparin is also sometimes given in pregnancy.
  Gout can be controlled by reducing the number of red cells and using allopurinol to reduce the symptoms. An acute attack of gout is managed with painkillers. Itching can be a particularly difficult problem to control there are a variety of treatments ranging from avoidance tactics, creams, ranitidine, antihistamines, anti-depressants and light therapy to ease these symptoms.
  
  

Read more about treatments for individual MPDs:
Essential thrombocythaemia (ET),
Polycythaemia Vera (PV),
Myelofibrosis (MF)

Next: Alternative treatments