What hematocrit (HCT) targets indicate phlebotomy needed for PVC?

Hi I am new to this platform and I was diagnosed back in 2019, I think. Anyhow I have never gone on medication only baby aspirin. But my oncologist will not allow my HCT to go above 44. Even if it is 45 They will do the phlebotomy therapy. Ugh cause now for last year they give me an IV along with it so procedure is longer (cause I had anxiety once and passed out during so now they do an IV both. Ugh
I love my oncologist but I feel fine if my HCT is a touch high. It is like once a month that I Am constantly being drained
My other levels normal HGB. Platelets. My RBC is slightly high
I have never had a blood clot and my energy level has improved as I am very exercise conscious and love to be on the go
After reading other postings. I am wondering if I should change oncologist since they constantly do phlebotomy when it rises above 44.
I am 75. And tired of dr appointments when I am actually starting to feel much better.
Should I change oncologist since??

Wow. A year. I have PCV but I only take a baby aspirin. I have refused medication so I am constantly having to have phlebotomy. My oncologist will do when it is above 44. Even if it is only 44.5. It is annoying. I get blood work done every 2 weeks and usually one a month it goes over 44 I have never had a blood clot. My platelets. HGB and other levels normal or 1 or 2 number varies. But seems so draining to constantly poke me
Any comments appreciate

Both of the oncologists I had would let it go a few points over 45 to avoid having back to back phlebotomies. The research shows that most symptoms come with PV patients actually comes from the iron deficiency from the excessive phlebotomies. We can not take iron. It increases the red cells and causes the numbers to go even higher so they try to find a balance. I would def go to someone else. Medications on a low dose can make your numbers stay lower longer and that should be an option, depending on your other health conditions. Tell them to check your iron levels too. My first doctor did not, only upon diagnosis and then I had issues. Good luck!

Sounds like you are dealing with a lot
I was diagnosed with PV
after having a stroke and two dvts while recovering in hospital. Immediately put on Eliquis and as soon as I was discharged my dr tested my blood and diagnosed me with PV I initially had two phlebotomies, then was prescribed hydroxyurea and have never had to have another phlebotomy (2018)
Dr wants my hct under 45
Never gone above 43
Oil/ hemat sees me and does bloodwork every two to three months

Regarding the concerns about clotting: I am also on a blood thinner as I had AFIB for some time. Even though it has been resolved, my doctor wants me to stay on the medication in the event that it returns without my knowing about it. I’m guessing that is why my Oncologist is OK with the higher readings.

My Hematologist wants my HCT below 45, so I have started phlebotomy every month. Not fun. Makes me tired and feel depleted. He is worried about stroke and Heart Attack. If I have to keep doing this to keep HCT down, then I will switch to Besremi injections. Not going there yet due to cost, but will consider it soon! I have ET, but by HCT is gradually going up to 48 at times. White count is above 10 but below 11, which is another milestone. Platelets have been fine on Hydroxyurea for years. staying below 500k. Hope this helps!

Thank you for your reply. Cannot take blood thineer and other meds, hence the
willingness for regular phlebotomy. Had kidney transplant in 2008, so my regimen of immunosuppressants restrict other medications. Hoping dr agrees to adjust phlebotomy routine to achieve HCT level in mid-40s. Continued good health.

Thank you for your response. Since JAK2 test was negative, I chose to go with phlebotomy. Like you, I refuse new meds whenever possible. Due to kidney transplant in 2008, my transplant team contols my med/treatments. Cannot take any risk with negative interaction with my immunosuppressants. The Lord has blessed me with good health over 18 yrs post-transplant. I view this secondary PV diagnosis ust a 'bump in the road' and believe phlebotomy is the most prudent approach for me. May God's blessings immerse you with continued good health.

Thank you for your response. Cannot take blood thinner, so I am fine with phlebotomy regimen whatever that turns out to be. Since I am kidney transplant patient, my transplant team conrols the meds to mke sure no risk of negative interaction with my immunosuppressants. All the best.

Wishing you the very best
with your plan with your dr
Sorry you’ve had to deal with so much