The patient is diagnosed with a myeloproliferative neoplasm. He is not keen on chemotherapy and is commenced on a venesection programme, aiming for Hct <0.45.
Although his counts start to show some improvement, he eventually becomes troubled by symptomatic iron deficiency and agrees to commence hydroxycarbamide therapy.
After several months, his counts eventually improve to normal ranges with a dose of 2g daily.
However, he starts developing leg ulcers and his treatment is stopped.
What are the treatment options now?