American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the mainstay of therapy for Polycythemia Vera?

1. Radiation therapy

2. Phlebotomy

3. Low-dose chemotherapy

4. Aspirin only

The correct answer is: Phlebotomy

The mainstay of therapy for Polycythemia Vera, a myeloproliferative neoplasm characterized by the overproduction of red blood cells, is phlebotomy. This procedure is essential in reducing the elevated hematocrit levels, which helps to decrease the risk of thrombotic events, such as stroke and myocardial infarction. By removing excess blood, phlebotomy effectively lowers blood viscosity, thereby improving circulation and alleviating symptoms associated with increased red blood cell mass. While other options might have roles in managing complications or associated symptoms, they do not address the primary issue in Polycythemia Vera to the extent that phlebotomy does. Radiation therapy is not commonly used as a primary treatment and is generally reserved for specific cases, such as splenic enlargement. Low-dose chemotherapy may be employed in high-risk patients to control platelet counts or reduce splenomegaly but is not the first-line treatment for all individuals. Aspirin, while helpful for cardiovascular protection in these patients, is an adjunctive treatment and does not replace the need for phlebotomy in managing the condition. Thus, phlebotomy remains the cornerstone for managing Polycythemia Vera effectively.