Page 19 - JSOM Winter 2022

match these levels, several strategies demonstrate significant Author Contributions
improvements in this regard. 1,12 Given a lack of most PV med- BMC, JAB, and PC conceived and wrote the first draft, and
ical therapies in an operational setting, the collocation of a all authors read, revised, and approved the final manuscript.
FWB transfusion kit with blood collection bag serves as a
readily available alternative for local medics to continue mea- References
sured phlebotomy apace without significant risk to the pa- 1. Meledeo MA, Fisher AD, Peltier GC, et al. Volumetric control of
tient. While FWB transfusion kits are not intended for routine whole blood collection in austere environments. J Trauma Acute
phlebotomy, the use of standardized blood collection bags and Care Surg. 2017;82(6S Suppl 1):S26–s32.
their ability to effectively estimate fill measurement enable lo- 2. Tefferi A, Vannucchi AM, Barbui T. Polycythemia vera treatment
algorithm 2018. Blood Cancer J. 2018;8(1):3.
cal personnel to perform this procedure. 3. Raedler LA. Diagnosis and management of polycythemia vera:
proceedings from a multidisciplinary roundtable. Am Health
Regardless of management, treatment strategies generally fo- Drug Benefits. 2014;7(7 Suppl 3):S36–47.
5
cus on an Hct goal of less than 45%. Prior trials have found 4. Spivak JL. How I treat polycythemia vera. Blood. 2019;134(4):
that those with excessive hematocrit of 45–50% demonstrate 341–352.
a four-fold increase in cardiovascular and thrombotic events 5. Reiter A, Harrison C. How we identify and manage patients with
inadequately controlled polycythemia vera. Curr Hematol Malig
13
compared to those at below 45%. Other markers of poorly Rep. 2016;11(5):356–367.
6
controlled PV include persistent leukocytosis (>10 × 10 /dL), 6. Parasuraman S, Yu J, Paranagama D, et al. Cytoreductive treat-
thrombocytosis (>400 × 10 /dL), and persistent symptoms. ment patterns among US veterans with polycythemia vera. BMC
5
6
Increased phlebotomy frequency can be considered for these Cancer. 2018;18(1):528.
patients, such as every 2–4 weeks. However, providers must 7. Army Regulation 40-501. Standards of medical fitness. 27 June
balance this with risks of iron deficiency, which can manifest 2019. https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/
ARN8673_AR40_501_FINAL_WEB.pdf. Accessed 15 July 2022.
with restless leg syndrome and cognitive dysfunction. 5,14,15 8. DOD Instruction 6130.03. Medical standards for military ser-
While the case presented here does demonstrate the ability for vice: Appointment, enlistment, or induction. 16 May 2018.
a FWB transfusion kit to be used successfully for PV manage- https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/
ment over an extended course, the single patient population dodi/613003_v1p.PDF?ver=9NsVi30gsHBBsRhMLcyVVQ
may limit its applicability to other patients. %3d%3d. Accessed 15 July 2022.
9. Holsworth RE, Jr., Cho YI, Weidman J. Effect of hydration on
whole blood viscosity in firefighters. Altern Ther Health Med.
Conclusion 2013;19(4):44–49.
10. Parasuraman S, Yu J, Paranagama D, et al. Hematocrit levels and
Although PV frequency is not well-defined in the military, there thrombotic events in patients with polycythemia vera: an analy-
is potential for encountering this diagnosis in an active-duty sis of Veterans Health Administration data. Ann Hematol. 2019;
Servicemember or among the foreign civilian population. 98(11):2533–2539.
Regimented therapeutic phlebotomy is vital as a general lack 11. Barbui T, Carobbio A, Ghirardi A, et al. No correlation of intensity
of or subtherapeutic treatment can be fatal. This case report of phlebotomy regimen with risk of thrombosis in polycythemia
vera: evidence from European collaboration on low-dose aspirin
demonstrates that local medical personnel can successfully in polycythemia vera and vytoreductive therapy in Polycythemia
and safely perform this therapy using existing WB transfusion Vera clinical trials. Haematologica. 2017;102(6):e219–e221.
kits, enabling the maintenance of diagnosed Servicemembers 12. Strandenes G, De Pasquale M, Cap AP, et al. Emergency whole-
in austere operational environments with minimal specialty blood use in the field: a simplified protocol for collection and
care consultation. transfusion. Shock (Augusta, Ga). 2014;41 Suppl 1:76–83.
13. Marchioli R, Finazzi G, Specchia G, et al. Cardiovascular events
and intensity of treatment in polycythemia vera. N Engl J Med.
Disclaimer 2013;368(1):22–33.
The view(s) expressed herein are those of the author(s) and do 14. Tobiasson M, Alyass B, Söderlund S, Birgegård G. High preva-
not reflect the official policy or position of the US Army Med- lence of restless legs syndrome among patients with polycytemia
ical Department, the US Army Office of the Surgeon General, vera treated with venesectio. Med Oncol. 2010;27(1):105–107.
the Department of the Army, or the Department of Defense or 15. Kim J, Wessling-Resnick M. Iron and mechanisms of emotional
the US Government. behavior. J Nutr Biochem. 2014;25(11):1101–1107.

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