On this episode, Pip and Rich discuss two of their recent publications on idiopathic and secondary polycythaemia. The first is an audit across two large hospitals in the Midlands. The team screened over 2000 patients who had had a JAK2 mutation screen performed, eventually finding 266 with confirmed idiopathic or secondary polycythaemia. By the time patients were seen, the haematocrit was already dropping. 60% were never venesected and venesection seemed to make no difference to haematocrits and had no association with thrombotic events. In the second paper which was a survey of clinicans, practice was, as expected, shown to be variable. 85% responded to say that they would be willing to randomise patients to a clinical trial of venesection vs no venesection.

This is an interesting discussion on a common situation for which there is almost no academic interest whatsoever. However, it is a big clinical problem - there is a lot of work for haematologists here. The evidence does not support treating this group of patients in any way shape or form and a trial to prove non-inferiority of no venesection is very much needed.

Here are the links to the papers:

1. Maybury et al. Venesection and resolution of erythrocytosis are not associated with reduced thrombotic risk in secondary and idiopathic polycythaemia: Results from a dual centre, 5-year retrospective study. Br J Haematol . 2025 Sep;207(3):1127-1132. doi: 10.1111/bjh.20235
2. Nicolson et al. Common Themes and Uncertainties in Management of Secondary Polycythaemia: An International Clinician Survey of Practice. EJHaem . 2025 Oct 27;6(6):e70171. doi: 10.1002/jha2.70171

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