How would you manage a patient with JAK2-positive PV who is not responding to hydroxyurea or IFN-alpha for cytoreduction?   

I would first evaluate for secondary von Willebrand. Continue ruxolitinib, and try to maximize dose. If HGB well controlled and platelets continue to increase, I would check iron, and replace it gently to see if that would help the platelets. If that isn’t possible, or replacing iron doesn't h...

I have had success with anagrelide in uncontrolled thrombocytosis despite first line therapy. Controlling the platelet count may help with the bleeding which could be sec to acquired VWD (recommend testing pt).

Hydroxyurea resistance is well-documented in MPN patients. The real questions are, is the patient asymptomatic or does the patient require a surgical procedure and has a prolonged ristocetin cofactor assay? For the latter, if it is a minor procedure (dental or dermatologic), tranexamic acid should b...