Fatigue is the most common PV constitutional symptom; however, if you did not experience the fatigue prior to starting cytoreduction with HU, then the PV is likely not the issue. The HCT and HGB levels you list are not considered anemic for a female. While 3.5 is slightly low, it does not seem likely that these numbers would result in fatigue.

Fatigue (asthenia/dyspnea) is a common HU adverse effect. If the fatigue you experience did not start until after initiating cytoreduction with HU, then it is reasonable to think that the HU is causing the fatigue.

I was unable to tolerate HU and was refractory to it. The long-term impact of phlebotomies included fatigue for me. When I initiated treatment with the interferons (Pegasys then switched to Besremi), my energy levels improved. My quality of life is significantly better on Besremi. I feel better now than I did 10 years ago.

HU can control blood counts, but at a cost. HU is not disease modifying. Jakafi and Besremi/Pegasys are disease modifying, potentially reducing the JAK2 allele burden. While noting that we are all different in how we respond, many of us find Jakafi and Besremi to be easier to tolerate and more effective than HU.

No one can predict how you would respond to a change to Jakafi, but given what you describe, trying would be justified. You will only know if you try.

Wishing you all the best.

Dinah, I could not tolerate Hydroxyurea. I have PV and Dr said Jakafi was a good drug for it. Jakafi brought my bloodwork to normal and took away most of my fatigue, I say most because some days I still have some fatigue but feel good most days. I'm so glad Dr switched me from Hydroxyurea to Jakafi. I've been on it going on 3 years.

Hi, Dinah. I was on HU for about ten plus years, with no side effects. However, I morphed into myelofibrosis [very rare] and have been on Jakafi since last September. I have no pain, and my fatigue has lessened a great deal. I will keep you in my heart and prayers.

PV diagnosed in 2011 and HU treatment continued through 2018. Side effects with HU included skin aberrations near each ankle with a skin graft for my left ankle/leg. Initiated Jakafi in 2018 and all blood issues returned to normal in early 2024. Presently being monitored 3 times per year.

I was made anemic by PV, HU, and phlebotomies and am scheduled for an 8 hour iron infusion on 7-10 at the Huntsman in Salt Lake City...