A 45-year-old woman presents with polycythemia vera (JAK2 V617F positive). She has no prior thrombosis. She is 42 years old. Her initial cytoreductive therapy should be:
- A Hydroxyurea as first-line cytoreduction ✓
- B Phlebotomy only; no cytoreduction needed
- C Ruxolitinib as first-line therapy
- D Busulfan for cytoreduction
Explanation
In polycythemia vera, risk stratification determines management. High-risk features include age > 60 years OR prior thrombosis. This 45-year-old patient with no prior thrombosis is low-to-intermediate risk but at age 42, cytoreduction may not yet be mandated. However, if cytoreduction is indicated, hydroxyurea is the first-line cytoreductive agent per ELN guidelines. Ruxolitinib (JAK1/2 inhibitor) is indicated for hydroxyurea-resistant or intolerant cases. Phlebotomy alone targets hematocrit < 45% for symptom and thrombosis risk management. Busulfan is a second-line alkylating agent used only in special circumstances due to leukemogenic risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.