DEAR DR. ROACH: My husband was diagnosed with secondary polycythemia in 2011. His hematocrit test (HCT) was 57%. He was referred to a hematologist. The hematologist would order a phlebotomy when his HCT was high. My husband decided to go to a Veterans Affairs health care center for his care to save money.

He saw a nurse practitioner at the VA. She said the new guidelines for treating secondary polycythemia that is not genetic is to go by symptoms, not numbers. She refused to order phlebotomies unless he was having dizzy spells or headaches. His HCT was 54.3%. He never had dizziness or headaches when his HCT was high.

He returned to his hematologist, who ordered him to have phlebotomies. His blood kept clotting during the phlebotomy. Are there new guidelines to go by the symptoms and not

See Full Page