Symptom Burden Iron Dysregulation and Phlebotomy Impact in PV

This section focuses on the interconnected relationship between symptom burden, iron dysregulation, and the cumulative effects of phlebotomy in polycythemia vera. Faculty describe fatigue, brain fog, and cognitive impairment as common and often debilitating symptoms that are under addressed in routine care. These symptoms are multifactorial and may be driven by iron deficiency, chronic inflammation, treatment effects, and comorbid conditions. Numeric symptom scales alone may be insufficient, and clinicians are encouraged to assess functional impact through questions about daily activities, work performance, and social engagement.

The discussion highlights that repeated phlebotomies, while effective at lowering hematocrit, frequently exacerbate iron deficiency and may worsen fatigue and cognitive symptoms. Beyond physical effects, the emotional and logistical burden of frequent clinic visits is emphasized. Patients often face travel time, scheduling disruptions, and repeated reminders of their diagnosis, all of which can negatively affect quality of life. Faculty note that these burdens are commonly underestimated by clinicians.

Emerging data on therapies targeting iron regulation are discussed as a potential way to maintain hematocrit control while reducing phlebotomy frequency. The experts stress that improving patient education around iron metabolism and symptom causation can validate patient experiences and support shared decision making. This section reinforces the need to view symptom assessment and iron management as integral components of comprehensive PV care rather than secondary considerations.