Doctor prescribed hydroxyurea before an MPN diagnosis?
A family member (F/75) recently had blood tests that came back with highly elevated platelets (904, follow ups 955 and 977), moderately elevated hematocrit/hemoglobin/RBC, and normal WBC. She has not had blood work done in many years so we don't know how long this problem has been going on, and is otherwise very healthy. She was referred to a hematologist, who ordered a full panel of genetic testing and prescribed 500 mg hydroxyurea/day + 1 baby aspirin/day.
The hematologist is not an MPN specialist, and was extremely dismissive and irritated when we asked follow up questions. We will be transferring her care to someone else ASAP.
After reading up on HU, my family member does not want to start a drug that causes DNA damage (would prefer a more targeted approach if it is a primary blood cancer, looking into alternatives), especially before genetic testing and ideally a bone marrow biopsy. We are also still hopeful that at least the elevated RBC/hemotacrit may be due to sleep apnea, and the platelet count could be due to a dental infection or other undiagnosed inflammation.
How unusual is it for a hematologist to prescribe HU before receiving these genetic test results and ordering a bone marrow biopsy? And is the risk of clotting that extreme for someone without symptoms or history of clotting? Should we ask for plateletpheresis while awaiting results? Thanks!