Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by an increase in red blood cell mass. Thrombotic complications are the main cause of morbidity and mortality in PV. Elevated hematocrit and increased blood viscosity are crucial risk factors for thrombus formation. The aim of our analysis is to evaluate the biochemical alterations in red blood cells (RBCs) and the hemoglobin structure in patients with PV that may be associated with thrombotic complications.

Blood samples were taken from 20 PV patients and 16 healthy individuals. The isolated RBCs were examined using Raman spectroscopy.

We found a larger contribution of ferrous heme iron, which is a molecular state typical for deoxyhemoglobin in PV samples compared to the control samples. Furthermore, a significant increase in the Fe II/Fe III ratio in PV samples was correlated with a higher hematocrit (Hct) to hemoglobin (Hgb) ratio. A positive trend between a higher Fe II/ Fe III ratio and a higher RDW-SD and RDW-CV was observed in PV samples. In RBCs collected from PV patients we observed a less stable hemoglobin structure.

Higher values of RDW-SD and RDW-CV may reflect a higher Fe II/ Fe III and be a simple indicator of biochemical alterations in RBCs. A higher Hct/ Hgb ratio could indicate higher clonal myeloproliferative potential and be associated with shorter time to thrombosis in patients with PV. Our future analysis will focus on correlating the above observations with the prothrombotic activity to demonstrate a possible link between the biochemical alterations of RBCs and the thrombotic complications in PV.