Repeated phlebotomy in patients with polycythemia vera (PV) may lead to the development of which condition?

Repeated phlebotomy in patients with polycythemia vera (PV) is a common therapeutic approach to reduce elevated red blood cell mass and decrease blood viscosity. However, this frequent removal of blood can lead to the depletion of iron stores in the body. Essentially, since red blood cell production is ongoing, the iron that is normally available for the synthesis of hemoglobin in red blood cells may become insufficient due to the loss of iron-containing blood. Consequently, the body can enter a state of iron deficiency anemia, characterized by lower hemoglobin levels, reduced red blood cell production, and fatigue among other symptoms.

While other conditions may also arise due to various causes in clinical settings, the connection between repeated phlebotomy and iron deficiency anemia is particularly relevant in the context of PV management. In this scenario, the loss of iron can overshadow the development of other types of anemia that are not directly linked to iron loss from the body.