What Does “Thick Blood” Mean? Mitigating Risk for Stroke and Clots in PV Patients

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Patient Power community member Philip writes in, “what does it mean that my blood is too thick?” During this Ask the Expert segment, noted myeloproliferative neoplasm (MPN) expert Dr. Joseph Scandura, from Weill Cornell Medicine, responds by describing how polycythemia vera (PV) patients’ blood vessels are impacted, short- and long-term risks associated with the condition and what treatments are available. Watch now to hear Dr. Scandura's expert opinion.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

So, this one comes from Philip who writes and he says, “I’m a 63-year-oldmale with PV, polycythemia vera. What does it mean that my blood is too thick?”

Dr. Scandura:              

What it’s probably referring to, the term too thick is a little bit—can be generalized in a lotof different directions. It’s a colloquial term, not really a medical term, but what people often are referring to there in the context of polycythemia vera is too many red blood cells. If you think of the blood vessels in your body as being highways, they can only accommodate a certain amount of traffic. And you being in southern California are probably aware of this, that sometimes there’stoo many people trying to get on the highway at the same time and that slows everything down. You could consider the highways too thick in that situation and that’s what’s really happening in polycythemia vera. 

There aretoo many red blood cells. Thereare about 1,000 red blood cells for every of the white blood cells there, so the most common blood cell type and they occupy about half of the whole blood volume. And when you have too many being produced, they end up causing traffic jams in the blood vessels and that is what people are trying to describe when they’re saying the blood is too thick.

Andrew Schorr:          

And you’re at risk for stroke and blood clots?

Dr. Scandura:              

Yeah. So, it has a lot of both short-termand long-termconsequences. Short-term certainly it provides a risk of having abnormal blood clots. That can be in an artery, so that could be a stroke, an artery in your brain, or an artery in your heart, a myocardial infarction or heart attack. It can also be a clot in a vein and so these, I’m sure you’ve seen them on TV, the advertisements for DVT or deep venous thrombosis or pulmonary embolism which is usually a clot in a vein that then has broken off and traveled through the circulation and landed in the lung where it can cause symptoms there. And so, the short-termrisks of a clot are certainly elevated in people with polycythemia vera when the blood counts aren’t controlled. 

Andrew Schorr:          

Okay. Just one follow-up question. Philip was wondering about this too. So, we see ads on TV whether it’s the DVT medicine ads or the blood thinner ads. Does that apply to people with PV?

Dr. Scandura:              

It can. We treat people with PV to reduce the risk of a clot, but some people are diagnosed with a clot at the same time they’re diagnosed with PV and some people, even with the best of treatment, end up developing a clot. If it’s a clot in the vein, then one of the things that isa standard of care is to administer drugs that colloquiallyagain are referred to as blood thinners. In this context,it has a different meaning and this is a group of drugs that interfere with the blood clotting system. So, these are proteins, not cells, and it’s what—if you ever have cut yourself and you feel just with your fingers, it gets a little sticky between the fingers. That’s actually clotting.

It’s a little bit like Jell-O. It starts out liquid and then it solidifiesand that’s what your body does to help prevent bleeding. It forms this sort of polymer fiber that ends up being part of the plug. And what the blood thinning medications, the so-calledblood thinning medications, do is they interfere with that process. Either given by injection or given by pill, the ultimate goal is to reduce the formation of that sort of sticky acellular clot. And that’s more of a treatment and can be a preventative for future clots as well, but it’s a little different than what we were talking about before in terms of too thick blood from too many red blood cells.

Andrew Schorr:          

Too many cells versus the quality of the cells. 

Dr. Scandura:              

Yeah, but not even the cells. A lot of the blood clotting factors are produced by your liver. They’re not from the cells themselves that are floating around in the blood. 

Andrew Schorr:          

I’ve never understood that before. So, thanks for explaining. I should also just say one thing about Philip. He shared with us that he has AFib. So, when somebody, and that’s not uncommonatrial fibrillation, does that complicate all the treatment for somebody with PV?

Dr. Scandura:              

Well, one of the risks with AFib, some of them can be just related to the heart, it can disturb a little bit in how the heart functions and if people have some mild symptoms, AFib can make symptoms worse just from a heart function standpoint. But one of the things that’s related to, again some of the commercials you see on TV and the rationalefor blood thinners, is the heart—the atrium, the left atrium which is really what fibrillates, which is just – normally the heart is pumping like this, all together coordinated. And what fibrillation means is it’ssort of not doing that. It’s going like this and what happens is the blood and the surface of the heart ends up not being pushed out normally. 

And sometimes actually clots can form on the surface of that fibrillating heart and then when they get pushed out, they can travel. And because it’s usually the left atrium where this happens, when they travel they go into the arteries and then they can form clots and that can be stroke is the big thing people worry about. So, you can have atrial fibrillation that puts you at risk for stroke and that’s why people think about anti-coagulation medications to prevent that risk. And so, again, that’s another rationalefor bloodthinner, although it has nothing to do with the blood being too thick. It has to do with atrial fibrillation itself.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on February 19, 2019