Key messages

• Primary polycythemia, posing risks of vascular occlusive disease, demands urgent treatment with venesection, cytotoxic agents, and aspirin.

• Although secondary polycythemia benefits oxygen transport in hypoxemic patients, venesection may be necessary to reduce hematocrit values in excess of 0.65.

• 'Dilution-venesection' should be considered for patients with apparent ('stress') polycythemia and hematocrit values of more than 0.55. introduction

When polycythemia has been diagnosed and categorized as primary, secondary, or due to a contracted plasma volume, the therapeutic decision regarding clinical management has to be taken.

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