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Koseoglu FD, Keklik Karadag F, Bulbul H, Alici EU, Ozyilmaz B, Ozdemir TR. JAKCalc: A machine-learning approach to rationalized JAK2 testing in patients with elevated hemoglobin levels. Medicine (Baltimore) 2024; 103:e37751. [PMID: 38579024 PMCID: PMC10994541 DOI: 10.1097/md.0000000000037751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 04/07/2024] Open
Abstract
The demand for Janus Kinase-2 (JAK2) testing has been disproportionate to the low yield of positive results, which highlights the need for more discerning test strategies. The aim of this study is to introduce an artificial intelligence application as a more rational approach for testing JAK2 mutations in cases of erythrocytosis. Test results were sourced from samples sent to a tertiary hospital's genetic laboratory between 2017 and 2023, meeting 2016 World Health Organization criteria for JAK2V617F mutation testing. The JAK2 Somatic Mutation Screening Kit was used for genetic testing. Machine learning models were trained and tested using Python programming language. Out of 458 cases, JAK2V617F mutation was identified in 13.3%. There were significant differences in complete blood count parameters between mutation carriers and non-carriers. Various models were trained with data, with the random forest (RF) model demonstrating superior precision, recall, F1-score, accuracy, and area under the receiver operating characteristic, all reaching 100%. Gradient boosting (GB) model also showed high scores. When compared with existing algorithms, the RF and GB models displayed superior performance. The RF and GB models outperformed other methods in accurately identifying and classifying erythrocytosis cases, offering potential reductions in unnecessary testing and costs.
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Affiliation(s)
- Fatos Dilan Koseoglu
- Department of Internal Medicine Division of Hematology, Izmir Bakircay University Faculty of Medicine, Cigli Hospital, İzmir, Turkey
| | | | - Hale Bulbul
- Department of Hematology, Tepecik Training and Research Hospital, İzmir, Turkey
| | | | - Berk Ozyilmaz
- Department of Medical Genetics, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Taha Resid Ozdemir
- Department of Medical Genetics, Tepecik Training and Research Hospital, İzmir, Turkey
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Rosato BE, Marra R, Del Giudice F, Nostroso A, Gobbi S, Bruschi B, Coccia P, Monaco V, Monti M, Iolascon A, Andolfo I, Russo R. One gene, two opposite phenotypes: a case report of hereditary anemia due to a loss-of-function variant in the EPAS1 gene. Haematologica 2023; 108:2872-2876. [PMID: 37102609 PMCID: PMC10543174 DOI: 10.3324/haematol.2022.282457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Barbara Eleni Rosato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate Franco Salvatore, Naples
| | - Roberta Marra
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate Franco Salvatore, Naples
| | | | - Antonella Nostroso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate Franco Salvatore, Naples
| | - Simona Gobbi
- Oncoematologia Pediatrica, AOU Ospedali Riuniti, Ancona
| | | | - Paola Coccia
- Oncoematologia Pediatrica, AOU Ospedali Riuniti, Ancona
| | - Vittoria Monaco
- CEINGE Biotecnologie Avanzate Franco Salvatore, Naples, Italy; Dipartimento di Scienze Chimiche, Università degli Studi di Napoli Federico II, Napoli
| | - Maria Monti
- CEINGE Biotecnologie Avanzate Franco Salvatore, Naples, Italy; Dipartimento di Scienze Chimiche, Università degli Studi di Napoli Federico II, Napoli
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate Franco Salvatore, Naples
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate Franco Salvatore, Naples.
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate Franco Salvatore, Naples.
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Reis M, Tavares J, Malheiro J, Almeida M, Pedroso S, Dias L, Henriques AC, Cabrita A, Martins LS. Is Erythrocytosis More Common After Simultaneous Pancreas Kidney Transplantation? A Single-Center Experience. Transplant Proc 2023; 55:1411-1415. [PMID: 37147196 DOI: 10.1016/j.transproceed.2023.03.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/31/2023] [Indexed: 05/07/2023]
Abstract
Post-transplant erythrocytosis (PTE) is reported in 8% to 22% of kidney transplant recipients. Few studies have evaluated the prevalence of PTE in simultaneous kidney-pancreas transplantation (SPKT). This study aimed to evaluate the prevalence of PTE in a cohort of SPKT and same-donor single kidney transplant patients and find predictive factors for erythrocytosis development. A single-center retrospective cohort study was performed with 65 SPKT recipients and 65 same-donor single kidney transplant patients. Post-transplant erythrocytosis was defined as a hematocrit persistently >51% without a known cause of erythrocytosis. The PTE prevalence was 23.1% and was more frequent in SPKT patients than in single donor patients (38.5% vs 7.7%; P < .001). The mean time for PTE development was 11.2 ± 13.3 months. In the multivariate model, SPKT was the only predictor for PTE development. De novo hypertension was more frequent in the PTE group (P = .002), but there was no difference in stroke and pancreatic or kidney thrombosis occurrence. Post-transplant erythrocytosis is more common after SPKT than after single kidney transplantation. De novo hypertension was more frequent in the erythrocytosis group, but allograft thrombosis rates.
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Affiliation(s)
- Marina Reis
- Nephrology Department, Coimbra University Hospital Center, Coimbra, Portugal; Nephrology University Clinic, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Joana Tavares
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Medical School of the Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Manuela Almeida
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Medical School of the Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Sofia Pedroso
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal
| | - Leonidio Dias
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal
| | - António Castro Henriques
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Medical School of the Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - António Cabrita
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal
| | - La Salete Martins
- Nephrology Department, University Hospital Center of Porto, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Medical School of the Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Babakhanlou R, Verstovsek S, Pemmaraju N, Rojas-Hernandez CM. Secondary erythrocytosis. Expert Rev Hematol 2023; 16:245-251. [PMID: 36927204 DOI: 10.1080/17474086.2023.2192475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Erythrocytosis is associated with an elevation of the hemoglobin level above 16.5 g/dL in men and above 16 g/dL in women and an elevation of the hematocrit level above 49% in men and > 48% in women. In primary erythrocytosis, the defect is a clonal disorder in the myeloid compartment of the bone marrow, leading to an increased red cell production. Secondary erythrocytosis is the result of external stimuli to the bone marrow, leading to the production of red cells in excess. Secondary erythrocytosis is more common than primary erythrocytosis and has a broad differential diagnosis. AREAS COVERED This review will discuss secondary erythrocytosis, its causes, clinical presentation, and both diagnostic and therapeutic approaches. EXPERT OPINION Although secondary erythrocytosis is more common than PV, there are still challenges and difficulties associated with the distinction between these two conditions. Moreover, there is a paucity of data and guidance when it comes to the management of certain congenital and acquired conditions. A pragmatic approach is recommended in order to identify the cause for this condition. Treatment should be directed at the management of the underlying cause.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Srdan Verstovsek
- Department of Leukemia, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Pemmaraju
- Department of Leukemia, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tariq S, Ismail D, Thapa M, Goriparthi L, Pradeep R, Khalid K, Cooper AC, Jean-Charles G. Chronic Obstructive Pulmonary Disease and Its Effect on Red Blood Cell Indices. Cureus 2023; 15:e36100. [PMID: 37065412 PMCID: PMC10097512 DOI: 10.7759/cureus.36100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) constitutes a set of heterogeneous symptoms affecting millions of people worldwide. The associated comorbidities developing in COPD involve dysregulation in physiological pathways resulting from systemic inflammation in respiratory airways. In addition to mentioning the pathophysiology, stages, and consequences of COPD, this paper also defines red blood cell (RBC) indices such as hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, and RBC count. It explains the role of RBC indices and RBC structural abnormalities with disease severity and exacerbations in COPD patients. Although many factors have been studied as a marker of morbidity and mortality for COPD patients, RBC indices have emerged as revolutionary evidence. Therefore, the effectiveness of evaluating RBC indices in COPD patients and their importance as a negative predictor of survival, mortality, and clinical outcomes have been debated through rigorous literature reviews. Furthermore, the prevalence, mechanisms of development, and prognosis of underlying anemia and polycythemia in COPD have also been evaluated, with anemia most significantly associated with COPD. Therefore, more studies should be conducted to address underlying anemia in COPD patients to lessen the severity and disease burden. Correcting the RBC indices in COPD patients remarkably impacts the quality of life and reduces in-patient admissions, healthcare resource utilization, and costs. Hence, it is noteworthy to understand the significance of considering RBC indices while dealing with COPD patients.
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Kam CT, Ahmed S, Milligan F, Sip B. Acute limb ischaemia in a young male with secondary polycythaemia: A case report. Radiol Case Rep 2023; 18:596-598. [PMCID: PMC9703451 DOI: 10.1016/j.radcr.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/29/2022] Open
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Larsson AE, Andréasson B, Holmberg H, Liljeholm M, Själander A. Erythrocytosis, thrombocytosis, and rate of recurrent thromboembolic event-A population based cohort study. Eur J Haematol 2023; 110:608-617. [PMID: 36725666 DOI: 10.1111/ejh.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The management to reduce risk of thromboembolic complications in polycythemia vera and essential thrombocythemia are well established, but for other conditions with elevated hemoglobin, hematocrit, or platelets there are no consensus regarding treatment and follow up. AIMS To assess frequency of elevated blood values in patients with thromboembolic event, how many of these should be investigated further regarding myeloproliferative neoplasm and if the risk of recurrent event is depending on underlying condition. METHODS Retrospective cohort study of 3931 adult patients in the county of Norrbotten, Sweden, with thromboembolism during 2017 and 2018. RESULTS Of the 3931 patients, 1195 had either elevated Hb, HCT, or platelets fulfilling the 2016 revised WHO criteria for PV and ET, and out of these 411 should be evaluated regarding underlying myeloproliferative neoplasms. Unexplained thrombocytosis and secondary erythrocytosis were associated with the highest rate of recurrent event as well as the most inferior restricted mean survival time. CONCLUSION Elevated blood values are common in patients with thromboembolic event and the high risk of recurrent event and inferior restricted mean survival time in patients with unexplained thrombocytosis and secondary erythrocytosis implicates the importance of finding and managing the underlying condition.
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Affiliation(s)
| | | | - Henrik Holmberg
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Maria Liljeholm
- Department of Radiation Sciences, Umea University, Umea, Sweden
| | - Anders Själander
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Martelli V, Carelli E, Tomlinson GA, Orchanian-Cheff A, Kuo KHM, Lyons OD, Ryan CM. Prevalence of elevated hemoglobin and hematocrit levels in patients with obstructive sleep apnea and the impact of treatment with continuous positive airway pressure: a meta-analysis. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:889-901. [PMID: 35962574 DOI: 10.1080/16078454.2022.2109346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is reported to be a cause of secondary polycythemia. The present study (i) reviewed the literature reporting the prevalence of secondary polycythemia in patients with OSA and (ii) determined the effect of continuous positive airway pressure (CPAP) therapy on hemoglobin and hematocrit levels in patients with OSA. METHODS We searched MEDLINE, Embase and Cochrane for studies of adult patients with OSA that reported hemoglobin and/or hematocrit levels. We performed summary estimates of (i) polycythemia prevalence and a subgroup analysis according to OSA severity, and (ii) change in hemoglobin and hematocrit levels following treatment with CPAP. RESULTS Synthesis of seven studies including 3,654 patients revealed an overall polycythemia prevalence of 2% (95% CI 1-4%); 2% (95% CI 1-3%) in mild-to moderate and 6 % (95% CI 3-12%) in severe OSA. In the pooled analysis of ten single-arm trials including 434 patients, CPAP treatment reduced hemoglobin by 3.76 g/L (95% CI -4.73 to -2.80 g/L). Similarly, pooled analysis of ten single-arm trials including 356 patients without baseline polycythemia showed that CPAP treatment reduced hematocrit by 1.1% (95% CI -1.4 to -0.9%). CONCLUSION Our pooled analysis supports an increased prevalence of secondary polycythemia in OSA. This estimated prevalence is likely underestimated due to the change in the polycythemia diagnostic criteria in 2016. Future randomized controlled trials are needed to evaluate the effect of CPAP in patients with baseline polycythemia. HIGHLIGHTS Pooled analysis shows OSA is associated with an increased prevalence of secondary polycythemiaPrevalence of polycythemia is greater in severe OSACPAP treatment for OSA reduces both the hemoglobin and hematocrit.
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Affiliation(s)
| | - Eric Carelli
- Department of Medicine, University of Toronto, Toronto, Canada
| | - George A Tomlinson
- Toronto General Hospital Research Institute, Toronto, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Canada
| | - Kevin H M Kuo
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Medical Oncology & Hematology, University Health Network, Toronto, Canada
| | - Owen D Lyons
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology, Women's College Hospital, Toronto, Canada.,Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Canada.,Division of Respirology, University Health Network, Toronto, Canada
| | - Clodagh M Ryan
- Toronto General Hospital Research Institute, Toronto, Canada.,Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Canada.,Division of Respirology, University Health Network, Toronto, Canada
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9
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王 金, 方 金, 谢 宇, 马 薇, 惠 培, 苏 晓, 郭 斌, 陈 雪, 王 旭, 范 杰, 赵 媛. [Analysis of related factors in secondary erythrocytosis of obstructive sleep apnea hypopnea syndrome in Gansu province]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:338-342. [PMID: 35483682 PMCID: PMC10128252 DOI: 10.13201/j.issn.2096-7993.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Objective:To analyze the related factors of secondary erythrocytosis of obstructive sleep apnea(OSA) in Gansu province. Methods:Polysomnography recording and analysis from January 2013 to January 2021, A total of 448 OSA patients of long-resident Han nationality in Gansu province. Hemoglobin(Hb) values were divided into group A(Hb 120-160 g/L) 41 cases, B(Hb 161-179 g/L) 142 cases, C(Hb 180-199 g/L) 152 cases, D(Hb 200-219 g/L) 79 cases, and E(Hb ≥220 g/L) 30 cases. General clinical data, altitude of residence, disease course, apnea hypopnea index (AHI), and Lowest oxyhemoglobin(LSpO₂) were compared among these groups. Multivariate regression and ROC curves were used to analyze the influencing factors of OSA secondary erythrocytosis. Results:There were no significant differences in age, sex, and course of disease among groups A, B, C, D, and E (P>0.05).The altitude of group E was higher than that of groups A, B, C, and D (P<0.05), but there was no significant difference between groups A, B, C and D (P>0.05).AHI was significantly different among groups A, B, C, D, and E (P<0.05), groups C, D, and E were significantly higher than A; group D was significantly higher than B, C.LSpO₂ was significantly different among groups A, B, C, D, and E (P <0.05), groups B, C, D, and E was significantly lower than A; group D, E was significantly lower than B, C.MSpO₂ was significantly different among groups A, B, C, D, and E (P<0.05), groups B, C, D, and E was significantly lower A; groups D, E was significantly lower than B , C.Multivariate regression showed that the higher the altitude, the lower the MSpO₂, the more serious the secondary hyperhemoglobinemia.Age, course of the disease, AHI, and LSpO₂ were not the influencing factors of OSA secondary hemoglobin increase.The areas under the ROC curve for MSpO₂ and altitude to predict Hb≥180 g/L were 0.694(P<0.001) and 0.570(P=0.009), with statistically significant differences(Z=3.205, P=0.001). Conclusion:Altitude and MSpO₂ were independent risk factors for OSA secondary erythrocytosis; MSpO₂ predicted that Hb≥180 g/L in OSA patients was better than altitude.
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Affiliation(s)
- 金凤 王
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 金瑞 方
- 甘肃省人民医院日间诊疗中心Department of Day Care Center, Gansu Provincial Hospital
| | - 宇平 谢
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 薇 马
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 培林 惠
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 晓燕 苏
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 斌 郭
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 雪萍 陈
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 旭斌 王
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 杰 范
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 媛 赵
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
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Rayamajhi A, Pokhrel B, Khanal S, Shrestha A. Undiagnosed polycythemia, an uncommon cause of Wallenberg syndrome: A case report. Clin Case Rep 2022; 10:e05752. [PMID: 35474990 PMCID: PMC9020440 DOI: 10.1002/ccr3.5752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/23/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022] Open
Abstract
A 26‐year‐old man presented with difficulty swallowing, dizziness, hiccups, and Horner's syndrome. Clinical and neuroimaging collaboration confirmed lateral medullary syndrome. Polycythemia was identified as the only attributable risk factor. However, the cause of polycythemia could not be assessed further. Polycythemia was managed with phlebotomy.
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Affiliation(s)
- Aadesh Rayamajhi
- Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Biraj Pokhrel
- Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Shambhu Khanal
- Department of Internal Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Anjan Shrestha
- Department of Hemato‐oncology Tribhuvan University Teaching Hospital Kathmandu Nepal
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Echambadi Loganathan S, Kattaru S, Chandrasekhar C, Vengamma B, Sarma PVGK. Novel mutations in EPO-R and oxygen-dependent degradation (ODD) domain of EPAS1 genes-a causative reason for Congenital Erythrocytosis. Eur J Med Genet 2022; 65:104493. [PMID: 35395428 DOI: 10.1016/j.ejmg.2022.104493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 12/12/2022]
Abstract
Congenital Erythrocytosis (CE) can be primary or secondary due to the mutations in genes involved in the erythropoietin receptor and oxygen sensing pathway. In this study, 42 patients with 38 unrelated patients and one family (4 patients) who were JAK-2 mutation (both exon 12 and exon 14) negative with high haematocrit values were investigated. The Endogenous Erythroid colony (EEC) assay was performed in all patients, interestingly EEC colonies were high in EPAS1 and EPOR mutated patients compared to non-mutated patients. The sequence analysis of EPAS1 (exon 12), EPO-R (exon-8), VHL (exon-3), and EGLN1 (exon-1) genes in all these patients showed 19% of patients (8/42) had mutations, in exon12 of EPAS1 and exon 8 of EPO-R genes. Two novel missense mutations MW_600850:c.1183G>C, MW_600851:c.1028A>C in EPO-R gene were observed in the study group. One new MW_600849:c.1969C>T nonsense mutation and five MW_619914:c.1715A>G, MW_619915:c.1694G>T, MW_619916:c.1634T>C, MW_600852:c.1771C>G, MW_600848:c.1859G>A novel missense mutations were observed in the EPAS1 gene. Among them, 4 mutations p. (Gln572Arg), p. (Ser565Ile), p. (Ile545Thr), p. (Gln591Glu) in the ODD (Oxygen-dependent degradation) domain of HIF2α, all these variations contributed to the formation of non-functional HIF2α. No mutations were observed in VHL and EGLN1 genes. Using in silico analysis we observed that these mutations contributed to major conformational changes in the HIF2α protein making it non-functional. The mutations in the EPAS1 gene were heterozygous and show autosomal dominant inheritance patterns and we observed in one family. These novel mutations in the EPAS1 (75% (6/8)) and 25% (2/8) EPO-R genes correlating with EEC positivity were observed for the first time in India in CE patients.
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Affiliation(s)
| | - Surekha Kattaru
- Department of Biotechnology, Sri Venkateswara Institute of Medical Sciences and University, Tirupati, Andhra Pradesh, India
| | - Chodimella Chandrasekhar
- Department of Haematology, Sri Venkateswara Institute of Medical Sciences and University, Tirupati, Andhra Pradesh, India
| | - B Vengamma
- Department of Neurology, Sri Venkateswara Institute of Medical Sciences and University, Tirupati, Andhra Pradesh, India
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12
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Fasolino J, Oklu R, Palmer J, Hommos MS. Polycythemia secondary to renal cysts. J Nephrol 2022; 35:1743-1746. [PMID: 35013984 DOI: 10.1007/s40620-021-01215-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Affiliation(s)
- John Fasolino
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahmi Oklu
- Minimally Invasive Therapeutics Laboratory, Department of Vascular and Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Jeanne Palmer
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Musab S Hommos
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ, USA.
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13
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Yaman S, Basci S, Turan G, Ulu B, Yigenoglu T, Bahsi T, Erdem H, Dal M, Çakar M, Altuntas F. Face masks and polycythemia is the standard hemoglobin cutoff valid in the pandemic? IRAQI JOURNAL OF HEMATOLOGY 2022. [DOI: 10.4103/ijh.ijh_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Mercury Chloride Impacts on the Development of Erythrocytes and Megakaryocytes in Mice. TOXICS 2021; 9:toxics9100252. [PMID: 34678948 PMCID: PMC8537753 DOI: 10.3390/toxics9100252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 12/13/2022]
Abstract
Inorganic mercury (Hg2+) is a highly toxic heavy metal. The aim of this study was to investigate the impact of Hg2+ on the development of erythrocytes and megakaryocytes. B10.S mice (H-2s) and DBA/2 mice (H-2d) were administrated with 10 μM HgCl2 or 50 μM HgCl2 via drinking water for four weeks, and erythro-megakaryopoiesis was evaluated thereafter. The administration of 50 μM HgCl2 increased the number of erythrocytes and platelets in B10.S mice, which was not due to a reduced clearance for mature erythrocytes. The administration of 50 μM HgCl2, but not 10 μM HgCl2, increased the number of progenitors for erythrocytes and megakaryocytes in the bone marrow (BM) of B10.S mice, including erythroid-megakaryocyte progenitors (EMPs), burst-forming unit-erythroid progenitors (BFU-Es), colony-forming unit-erythroid progenitors (CFU-Es), and megakaryocyte progenitors (MkPs). Moreover, 50 μM HgCl2 caused EMPs to be more proliferative and possess an increased potential for differentiation into committed progenies in B10.S mice. Mechanistically, 50 μM HgCl2 increased the expression of the erythropoietin receptor (EPOR) in EMPs, thus enhancing the Jak2/STAT5 signaling pathway to promote erythro-megakaryopoiesis in B10.S mice. Conversely, 50 μM HgCl2 did not impact erythro-megakaryopoiesis in DBA/2 mice. This study may extend our current understanding for hematopoietic toxicology of Hg.
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15
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Kristan A, Pajič T, Maver A, Režen T, Kunej T, Količ R, Vuga A, Fink M, Žula Š, Podgornik H, Anžej Doma S, Preložnik Zupan I, Rozman D, Debeljak N. Identification of Variants Associated With Rare Hematological Disorder Erythrocytosis Using Targeted Next-Generation Sequencing Analysis. Front Genet 2021; 12:689868. [PMID: 34349782 PMCID: PMC8327209 DOI: 10.3389/fgene.2021.689868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
An erythrocytosis is present when the red blood cell mass is increased, demonstrated as elevated hemoglobin and hematocrit in the laboratory evaluation. Congenital predispositions for erythrocytosis are rare, with germline variants in several genes involved in oxygen sensing (VHL, EGLN1, and EPAS1), signaling for hematopoietic cell maturation (EPOR and EPO), and oxygen transfer (HBB, HBA1, HBA2, and BPGM) that were already associated with the eight congenital types (ECYT1–8). Screening for variants in known congenital erythrocytosis genes with classical sequencing approach gives a correct diagnosis for only up to one-third of the patients. The genetic background of erythrocytosis is more heterogeneous, and additional genes involved in erythropoiesis and iron metabolism could have a putative effect on the development of erythrocytosis. This study aimed to detect variants in patients with yet unexplained erythrocytosis using the next-generation sequencing (NGS) approach, targeting genes associated with erythrocytosis and increased iron uptake and implementing the diagnostics of congenital erythrocytosis in Slovenia. Selected 25 patients with high hemoglobin, high hematocrit, and no acquired causes were screened for variants in the 39 candidate genes. We identified one pathogenic variant in EPAS1 gene and three novel variants with yet unknown significance in genes EPAS1, JAK2, and SH2B3. Interestingly, a high proportion of patients were heterozygous carriers for two variants in HFE gene, otherwise pathogenic for the condition of iron overload. The association between the HFE variants and the development of erythrocytosis is not clearly understood. With a targeted NGS approach, we determined an actual genetic cause for the erythrocytosis in one patient and contributed to better management of the disease for the patient and his family. The effect of variants of unknown significance on the enhanced production of red blood cells needs to be further explored with functional analysis. This study is of great significance for the improvement of diagnosis of Slovenian patients with unexplained erythrocytosis and future research on the etiology of this rare hematological disorder.
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Affiliation(s)
- Aleša Kristan
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Pajič
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Clinical Biochemistry, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Aleš Maver
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadeja Režen
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Kunej
- Department of Animal Science, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Količ
- Kemomed Research and Development, Kemomed Ltd., Ljubljana, Slovenia
| | - Andrej Vuga
- Kemomed Research and Development, Kemomed Ltd., Ljubljana, Slovenia
| | - Martina Fink
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Špela Žula
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Podgornik
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Saša Anžej Doma
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Damjana Rozman
- Centre for Functional Genomics and Bio-Chips, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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16
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Alzoubi B, Kharel A, Machhi R, Aziz F, Swanson KJ, Parajuli S. Post-transplant erythrocytosis after kidney transplantation: A review. World J Transplant 2021; 11:220-230. [PMID: 34164297 PMCID: PMC8218346 DOI: 10.5500/wjt.v11.i6.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin > 17 g/dL or hematocrit levels > 51% following kidney transplantation, independent of duration. It is a relatively common complication within 8 months to 24 months post-transplantation, occurring in 8%-15% of kidney transplant recipients. Established PTE risk factors include male gender, normal hemoglobin/hematocrit pre-transplant (suggestive of robust native kidney erythropoietin production), renal artery stenosis, patients with a well-functioning graft, and dialysis before transplantation. Many factors play a role in the development of PTE, however, underlying endogenous erythropoietin secretion pre-and post-transplant is significant. Other contributory factors include the renin-angiotensin- aldosterone system, insulin-like growth factors, endogenous androgens, and local renal hypoxia. Most patients with PTE experience mild symptoms like malaise, headache, fatigue, and dizziness. While prior investigations showed an increased risk of thromboembolic events, more recent evidence tells a different story-that PTE perhaps has lessened risk of thromboembolic events or negative graft outcomes than previously thought. In the evaluation of PTE, it is important to exclude other causes of erythrocytosis including malignancy before treatment. Angiotensin converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) are the mainstays of treatment. Increased ACE-I/ARB use has likely contributed to the falling incidence of erythrocytosis. In this review article, we summarize the current literature in the field of post-transplant erythrocytosis after kidney transplantation.
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Affiliation(s)
- Beyann Alzoubi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
| | - Abish Kharel
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
| | - Rushad Machhi
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
| | - Fahad Aziz
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
| | - Kurtis J Swanson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
| | - Sandesh Parajuli
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53705, United States
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17
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Fuqua J, Reece J, Sofka S. Successful use of phlebotomy to treat severe secondary polycythemia due to chronic lung disease. Hematol Rep 2021; 13:8961. [PMID: 34221292 PMCID: PMC8215527 DOI: 10.4081/hr.2021.8961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Secondary polycythemia (SP) occurs as a result of increase erythropoietin levels most commonly as a result of tissue hypoxia. Symptoms such as erythromelalgia, pruritis, and bleeding, which are frequently seen in polycythemia vera (PV), do not commonly occur in SP. Phlebotomy is considered one of the mainstays of therapy for PV but is rarely used for treatment of SP due to concern about worsening tissue hypoxia. We present the case of a patient with severe SP due to chronic hypoxic lung disease who presented with erythromelalgia, pruritis, and bleeding and was treated successfully with therapeutic phlebotomy. This case illustrates the importance of considering the use of therapeutic phlebotomy in symptomatic patients with severe SP.
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Affiliation(s)
- Jacob Fuqua
- Department of Medicine, West Virginia University, Morgantown, WV, USA
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18
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Anžej Doma S, Drnovšek E, Kristan A, Fink M, Sever M, Podgornik H, Belčič Mikič T, Debeljak N, Preložnik Zupan I. Diagnosis and management of non-clonal erythrocytosis remains challenging: a single centre clinical experience. Ann Hematol 2021; 100:1965-1973. [PMID: 34013406 PMCID: PMC8285333 DOI: 10.1007/s00277-021-04546-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/01/2021] [Indexed: 12/31/2022]
Abstract
Erythrocytosis has a diverse background. While polycythaemia vera has well defined criteria, the diagnostic approach and management of other types of erythrocytosis are more challenging. The aim of study was to retrospectively analyse the aetiology and management of non-clonal erythrocytosis patients referred to a haematology outpatient clinic in an 8-year period using a 3-step algorithm. The first step was inclusion of patients with Hb > 185 g/L and/or Hct > 0.52 in men and Hb > 165 g/L and/or Hct > 0.48 in women on two visits ≥ two months apart, thus confirming true erythrocytosis. Secondly, polycythaemia vera was excluded and secondary causes of erythrocytosis (SE) identified. Thirdly, idiopathic erythrocytosis patients (IE) were referred to next-generation sequencing for possible genetic background evaluation. Of the 116 patients, 75 (65%) are men and 41 (35%) women, with non-clonal erythrocytosis 34/116 (29%) had SE, 15/116 (13%) IE and 67/116 (58%) stayed incompletely characterized (ICE). Patients with SE were significantly older and had significantly higher Hb and Hct compared to patients with IE. Most frequently, SE was attributed to obstructive sleep apnoea and smoking. Phlebotomies were performed in 56, 53 and 40% of patients in the SE, IE, and ICE group, respectively. Approx. 70% of patients in each group received aspirin. Thrombotic events were registered in 12, 20 and 15% of SE, IE and ICE patients, respectively. Congenital erythrocytosis type 4 (ECYT4) was diagnosed in one patient. The study demonstrates real-life management of non-clonal erythrocytosis which could be optimized using a 3-step diagnostic algorithm.
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Affiliation(s)
- Saša Anžej Doma
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Eva Drnovšek
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Aleša Kristan
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Martina Fink
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Matjaž Sever
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Helena Podgornik
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000, Ljubljana, Slovenia
| | - Tanja Belčič Mikič
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia
| | - Nataša Debeljak
- Medical Centre for Molecular Biology, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Department of Haematology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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19
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Kristan A, Gašperšič J, Režen T, Kunej T, Količ R, Vuga A, Fink M, Žula Š, Anžej Doma S, Preložnik Zupan I, Pajič T, Podgornik H, Debeljak N. Genetic analysis of 39 erythrocytosis and hereditary hemochromatosis-associated genes in the Slovenian family with idiopathic erythrocytosis. J Clin Lab Anal 2021; 35:e23715. [PMID: 33534944 PMCID: PMC8059723 DOI: 10.1002/jcla.23715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/10/2020] [Accepted: 01/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Erythrocytosis is a condition with an excessive number of erythrocytes, accompanied by an elevated haemoglobin and/or haematocrit value. Congenital erythrocytosis has a diverse genetic background with several genes involved in erythropoiesis. In clinical practice, nine genes are usually examined, but in approximately 70% of patients, no causative mutation can be identified. In this study, we screened 39 genes, aiming to identify potential disease-driving variants in the family with erythrocytosis of unknown cause. PATIENTS AND METHODS Two affected family members with elevated haemoglobin and/or haematocrit and negative for acquired causes and one healthy relative from the same family were selected for molecular-genetic analysis of 24 erythrocytosis and 15 hereditary haemochromatosis-associated genes with targeted NGS. The identified variants were further analysed for pathogenicity using various bioinformatic tools and review of the literature. RESULTS Of the 12 identified variants, two heterozygous variants, the missense variant c.471G>C (NM_022051.2) (p.(Gln157His)) in the EGLN1 gene and the intron variant c.2572-13A>G (NM_004972.3) in the JAK2 gene, were classified as low-frequency variants in European population. None of the two variants were present in a healthy family member. Variant c.2572-13A>G has potential impact on splicing by one prediction tool. CONCLUSION For the first time, we included 39 genes in the erythrocytosis clinical panel and identified two potential disease-driving variants in the Slovene family studied. Based on the reported functional in vitro studies combined with our bioinformatics analysis, we suggest further functional analysis of variant in the JAK2 gene and evaluation of a cumulative effect of both variants.
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Affiliation(s)
- Aleša Kristan
- Medical Centre for Molecular BiologyFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
| | - Jernej Gašperšič
- Medical Centre for Molecular BiologyFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
| | - Tadeja Režen
- Centre for Functional Genomics and Bio‐ChipsFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
| | - Tanja Kunej
- Department of Animal ScienceBiotechnical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Rok Količ
- Kemomed Research and DevelopmentKemomed LtdKranjSlovenia
| | - Andrej Vuga
- Kemomed Research and DevelopmentKemomed LtdKranjSlovenia
| | - Martina Fink
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Špela Žula
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Saša Anžej Doma
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Irena Preložnik Zupan
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Department of Internal MedicineFaculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Tadej Pajič
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Clinical Institute of Genomic MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Helena Podgornik
- Clinical Department of HaematologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
- Chair of Clinical BiochemistryFaculty of PharmacyUniversity of LjubljanaLjubljanaSlovenia
| | - Nataša Debeljak
- Medical Centre for Molecular BiologyFaculty of MedicineInstitute of Biochemistry and Molecular GeneticsUniversity of LjubljanaLjubljanaSlovenia
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20
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An Excessive Testosterone Producing Testicular Leydig Cell Tumor as a Rare Cause of Secondary Acquired Erythrocytosis. Urology 2020; 142:e32-e35. [DOI: 10.1016/j.urology.2020.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 01/07/2023]
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21
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Grenier M, Callegarin D, Nughe M, Gardie B, Riedinger JM, Girodon F. Can absolute polycythaemia be identified without measurement of the red cell mass? Br J Haematol 2020; 190:e107-e110. [PMID: 32430918 DOI: 10.1111/bjh.16747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Mélanie Grenier
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon, France
| | - Davide Callegarin
- Laboratoire de génétique chromosomique et moléculaire, Pôle Biologie, CHU de Dijon, Dijon, France
| | - Mathilde Nughe
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon, France
| | - Betty Gardie
- L'institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.,Ecole Pratique des Hautes, EPHE, PSL Research University, Lyon, France.,Laboratoire d'Excellence GR-Ex, Paris, France
| | - Jean Marc Riedinger
- Laboratoire de Biologie Médicale, Centre George François Leclerc, Dijon, France
| | - François Girodon
- Service d'Hématologie Biologique, Pôle Biologie, CHU de Dijon, Dijon, France.,Laboratoire d'Excellence GR-Ex, Paris, France.,Inserm U1231, Université de Bourgogne, Dijon, France
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22
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Bonnin A, Gardie B, Girodon F, Airaud F, Garrec C, Bézieau S, Vignon G, Mottaz P, Labrousse J, Lellouche F. [A new case of rare erythrocytosis due to EGLN1 mutation with review of the literature]. Rev Med Interne 2020; 41:196-199. [PMID: 31980185 DOI: 10.1016/j.revmed.2019.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The origin of polycythemia is often simple to detect. Sometimes it is necessary to look for hereditary forms, the decisive parameters being the dosage of erythropoietin and the measurement of the oxygen dissociation curve (P50). These rare diseases are related to high oxygen-affinity haemoglobins, abnormalities of the erythropoietin receptor or dysfunction of the HIF (hypoxia-inducible factor) pathway. CASE REPORT We report the case of a 56-year-old patient with unexplained polycythemia associated with normal serum erythropoietin and normal P50, in whom the never previously described mutation c.400C>T(p.Gln134*) on exon 1 in the EGLN1 gene (encoding PHD2) was found. CONCLUSION In the face of an unexplained polycythemia a good cooperation between clinicians and biologists is necessary to be able to characterize rare hereditary pathologies.
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Affiliation(s)
- A Bonnin
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de Saint-Sordelin, 17640 Vaux sur mer, France
| | - B Gardie
- École pratique des hautes études (EPHE), PSL research university, les Patios Saint-Jacques, 4-14, rue Ferrus, 75014 Paris, France; Inserm, centre national de la recherche scientifique (CNRS), institut du thorax, université de Nantes, 8, quai Moncousu, 44007 Nantes, France; Laboratory of excellence GR-Ex, Paris, France
| | - F Girodon
- Laboratory of excellence GR-Ex, Paris, France; Service d'hématologie biologique, pôle biologie, CHU de Dijon, hôpital du Bocage, 14, rue Paul-Gaffarel, 21000 Dijon, France; Inserm U1231, université de Bourgogne, 21000 Dijon, France
| | - F Airaud
- Service de génétique médicale, CHU de Nantes, 8, quai Moncousu, 44007 Nantes, France
| | - C Garrec
- Service de génétique médicale, CHU de Nantes, 8, quai Moncousu, 44007 Nantes, France
| | - S Bézieau
- Inserm, centre national de la recherche scientifique (CNRS), institut du thorax, université de Nantes, 8, quai Moncousu, 44007 Nantes, France; Service de génétique médicale, CHU de Nantes, 8, quai Moncousu, 44007 Nantes, France
| | - G Vignon
- Laboratoire inter-hospitalier de biologie médicale, groupement de coopération sanitaire de Saintonge, centres hospitaliers de Saint-Jean-d'Angély, Saintes, Royan et Jonzac, 18, avenue du Port, 17400 Saint-Jean-d'Angély, France
| | - P Mottaz
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de Saint-Sordelin, 17640 Vaux sur mer, France
| | - J Labrousse
- Laboratoire inter-hospitalier de biologie médicale, groupement de coopération sanitaire de Saintonge, centres hospitaliers de Saint-Jean-d'Angély, Saintes, Royan et Jonzac, 18, avenue du Port, 17400 Saint-Jean-d'Angély, France
| | - F Lellouche
- Service de médecine interne, centre hospitalier de Royan, 20, avenue de Saint-Sordelin, 17640 Vaux sur mer, France; Laboratoire inter-hospitalier de biologie médicale, groupement de coopération sanitaire de Saintonge, centres hospitaliers de Saint-Jean-d'Angély, Saintes, Royan et Jonzac, 18, avenue du Port, 17400 Saint-Jean-d'Angély, France.
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23
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Beydoun MA, Hossain S, Beydoun HA, Shaked D, Weiss J, Evans MK, Zonderman AB. Red Cell Distribution Width Is Directly Associated with Poor Cognitive Performance among Nonanemic, Middle-Aged, Urban Adults. J Nutr 2020; 150:128-139. [PMID: 31912144 PMCID: PMC6946901 DOI: 10.1093/jn/nxz182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/08/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Epidemiological evidence suggests that both anemia and elevated red cell distribution width (RDW) are associated with cognitive impairment. However, the interplay between these 2 predictors has been understudied. OBJECTIVES We examined sex- and anemia-specific associations between RDW and cognitive performance among urban adults in the United States. METHODS Data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study (Baltimore, MD; participants aged 30-65 y at baseline, ∼59% African-American, 45% men) were used. Participants were selected based on the completion of 11 cognitive tasks at baseline (2004-2009) and follow-up (2009-2013) visits (mean time between visits: 4.64 ± 0.93 y) and availability of exposure and covariate data, yielding a sample of between 1526 and 1646 adults out of the initial 3720 adults recruited at baseline. Multiple linear mixed-effects regression models were conducted with RDW as the main exposure of interest and anemia/sex as the key effect modifiers. RESULTS Overall, high RDWs were linked to poorer baseline performance on the California Verbal Learning Test (CVLT) List A (per 1 unit increase in RDW %, main effect: γ01 = -0.369 ± 0.114; P = 0.001) and to slower rates of decline on the CVLT Delayed Free Recall (per 1 unit increase in RDW %, RDW × time: γ11 = +0.036 ± 0.013; P = 0.007). Among nonanemic participants, RDWs were consistently associated with poorer baseline performance on the Trailmaking Test, Part A (γ01 = +3.11 ± 0.89; P < 0.001) and on the CVLT List A (γ01 = -0.560 ± 0.158; P < 0.001). Moreover, RDWs were associated with poorer baseline performance on the Brief Test of Attention in the total population (γ01 = -0.123 ± 0.039; P = 0.001) and among men (γ01 = -0.221 ± 0.068; P = 0.001). We did not detect an association between hemoglobin (Hb) and baseline cognitive performance or changes over time. CONCLUSIONS Elevated RDW had a consistent cross-sectional association with poor cognitive performance in the domains of verbal memory and attention among the nonanemic group in a sample of middle-aged, urban adults. Anemia and Hb concentrations were not associated with cognition. More longitudinal studies are needed to replicate our findings.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD, USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Danielle Shaked
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD, USA
| | - Jordan Weiss
- Population Studies Center and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Intramural Research Program, Baltimore, MD, USA
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Rumi E, McMullin MF, Harrison C, Ellis MH, Barzilai M, Sarid N, Mesa R, Paoli C, Angona A, Sant’Antonio E, Ferretti VV, Cavalloni C, Casetti IC, Trotti C, Barbui T. Facing erythrocytosis: Results of an international physician survey. Am J Hematol 2019; 94:E225-E227. [PMID: 31148218 PMCID: PMC8204407 DOI: 10.1002/ajh.25545] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Elisa Rumi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Claire Harrison
- Department of Hematology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Martin H. Ellis
- Hematology Institute, Meir Medical Center, Kfar Saba, Israel
| | - Merav Barzilai
- Hematology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadav Sarid
- Hematology Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ruben Mesa
- UT Health San Antonio Cancer Center, San Antonio, Texas
| | - Chiara Paoli
- CRIMM, Center Research and Innovation of Myeloproliferative Neoplasms, University of Florence, Florence, Italy
| | - Anna Angona
- Hematology Department-IMIM, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Chiara Cavalloni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Chiara Trotti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Tiziano Barbui
- Research Foundation Ospedale Papa Giovanni XXIII Bergamo, Bergamo, Italy
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25
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Lappin TR, Lee FS. Update on mutations in the HIF: EPO pathway and their role in erythrocytosis. Blood Rev 2019; 37:100590. [PMID: 31350093 DOI: 10.1016/j.blre.2019.100590] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022]
Abstract
Identification of the underlying defects in congenital erythrocytosis has provided mechanistic insights into the regulation of erythropoiesis and oxygen homeostasis. The Hypoxia Inducible Factor (HIF) pathway plays a key role in this regard. In this pathway, an enzyme, Prolyl Hydroxylase Domain protein 2 (PHD2), constitutively prolyl hydroxylates HIF-2α, thereby targeting HIF-2α for degradation by the von Hippel Lindau (VHL) tumor suppressor protein. Under hypoxia, this modification is attenuated, resulting in the stabilization of HIF-2α and transcriptional activation of the erythropoietin (EPO) gene. Circulating EPO then binds to the EPO receptor (EPOR) on red cell progenitors in the bone marrow, leading to expansion of red cell mass. Loss of function mutations in PHD2 and VHL, as well as gain of function mutations in HIF-2α and EPOR, are well established causes of erythrocytosis. Here, we highlight recent developments that show that the study of this condition is still evolving. Specifically, novel mutations have been identified that either change amino acids in the zinc finger domain of PHD2 or alter splicing of the VHL gene. In addition, continued study of HIF-2α mutations has revealed a distinctive genotype-phenotype correlation. Finally, novel mutations have recently been identified in the EPO gene itself. Thus, the cascade of genes that at a molecular level leads to EPO action, namely PHD2 - > HIF2A - > VHL - > EPO - > EPOR, are all mutational targets in congenital erythrocytosis.
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Affiliation(s)
- Terence R Lappin
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK.
| | - Frank S Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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26
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Oliveira JL. Algorithmic evaluation of hereditary erythrocytosis: Pathways and caveats. Int J Lab Hematol 2019; 41 Suppl 1:89-94. [PMID: 31069987 DOI: 10.1111/ijlh.13019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 11/28/2022]
Abstract
Multiple algorithms have been published for the evaluation of hereditary erythrocytosis (HE). Typical entry points begin after excluding the more common acquired conditions through investigations of clinical history and assessment of cardiac, pulmonary, or vascular system disorders. Prior exclusion of JAK2 mutations, particularly the common JAK2 V617F mutation, is indicated in adults but less so in pediatric populations. Key decision trees are based on serum erythropoietin levels and p50 results. Recent data reveal some overlap in clinical presentation and laboratory findings in erythrocytosis. Caveats to consider when using algorithmic approaches are discussed.
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Affiliation(s)
- Jennifer L Oliveira
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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27
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Li N, Li HP, Wang P, Yan YR, Li SQ, Li QY. Nocturnal Mean Oxygen Saturation Is Associated with Secondary Polycythemia in Young Adults with Obstructive Sleep Apnea, Especially in Men. Nat Sci Sleep 2019; 11:377-386. [PMID: 31824198 PMCID: PMC6901050 DOI: 10.2147/nss.s226143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Whether the severity of obstructive sleep apnea (OSA) contributes to clinical polycythemia is uncertain, especially in young adults. This study aimed to assess the correlation between untreated OSA and polycythemia, controlling for multiple confounders, and to observe the difference in both genders. METHODS All participants underwent nocturnal polysomnography. Medical comorbidities, and demographic and laboratory information were also recorded. The relationship between OSA and concomitant polycythemia in both genders was analyzed. RESULTS A total of 605 young participants (383 men and 222 women), aged 30.52 ± 7.21 years, were enrolled, with an average body mass index of 32.48 ± 6.06 kg/m2. Although 74.4% of patients were diagnosed with OSA, less than 10% had polycythemia. The levels of hemoglobin and hematocrit increased with the severity of OSA; only men with severe OSA had significantly higher hemoglobin, hematocrit, and polycythemia compared with those in the control group (P < 0.01). Hemoglobin and hematocrit significantly correlated with mean pulse oxygen saturation (SpO2) (P < 0.001), but the correlation coefficients were weaker in women than in men. In logistic regression analysis, mean SpO2, but not the apnea-hypopnea index (AHI), was found to be an independent predictor of polycythemia (P < 0.05). Areas under the receive operator characteristic analysis revealed that the cutoff values of hemoglobin and hematocrit were 155.5g/L and 44.6% (P < 0.001), respectively, for assessing nocturnal hypoxemia in men with OSA. CONCLUSION Nocturnal mean SpO2 was an independent predictor of polycythemia in young adults. Mean SpO2, compared with the AHI, was more associated with polycythemia. Men were more prone to suffer from polycythemia compared with women. Hemoglobin and hematocrit values might have diagnostic utility for assessing nocturnal hypoxia severity of OSA patients, especially in men.
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Affiliation(s)
- Ning Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ya Ru Yan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shi Qi Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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28
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Perricone M, Polverelli N, Martinelli G, Catani L, Ottaviani E, Zuffa E, Franchini E, Dizdari A, Forte D, Sabattini E, Cavo M, Vianelli N, Palandri F. The relevance of a low JAK2V617F allele burden in clinical practice: a monocentric study. Oncotarget 2018; 8:37239-37249. [PMID: 28422729 PMCID: PMC5514906 DOI: 10.18632/oncotarget.16744] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 03/20/2017] [Indexed: 02/02/2023] Open
Abstract
Since low JAK2V617F allele burden (AB) has been detected also in healthy subjects, its clinical interpretation may be challenging in patients with chronic myeloproliferative neoplasms (MPNs). We tested 1087 subjects for JAK2V617F mutation on suspicion of hematological malignancy. Only 497 (45.7%) patients were positive. Here we present clinical and laboratory parameters of a cohort of 35/497 patients with an AB ≤ 3%. Overall, 22/35 (62.9%) received a WHO-defined diagnosis of MPN and in 14/35 cases (40%) diagnosis was supported by bone marrow (BM) histology (‘’Histology-based’’ diagnosis). In patients that were unable or refused to perform BM evaluation, diagnosis relied on prospective clinical observation (12 cases, 34.3%) and molecular monitoring (6 cases, 17.1%) (‘’Clinical-based’’ or ‘’Molecular-based’’ diagnosis, respectively). In 11/35 (31.4%) patients, a low JAK2V617F AB was not conclusive of MPN. The probability to have a final hematological diagnosis (ET/PV/MF) was higher in patients with thrombocytosis than in patients with polyglobulia (73.7% vs 57.1%, respectively). The detection of AB ≥ 0.8% always corresponded to an overt MPN phenotype. The repetition of JAK2V617F evaluation over time timely detected the spontaneous expansion (11 cases) or reduction (4 cases) of JAK2V617F-positive clones and significantly oriented the diagnostic process. Our study confirms that histology is relevant to discriminate small foci of clonal hematopoiesis with uncertain clinical significance from a full blown disease. Remarkably, our data suggest that a cut-off of AB ≥ 0.8% is very indicative for the presence of a MPN. Monitoring of the AB over time emerged as a convenient and non-invasive method to assess clonal hematopoiesis expansion.
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Affiliation(s)
- Margherita Perricone
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Polverelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lucia Catani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Emanuela Ottaviani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Zuffa
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Eugenia Franchini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Arbana Dizdari
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Dorian Forte
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Michele Cavo
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Nicola Vianelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Palandri
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology 'L. and A. Seràgnoli', University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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29
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Myelodysplastic Syndrome/Acute Myeloid Leukemia Arising in Idiopathic Erythrocytosis. Case Rep Hematol 2018; 2018:4378310. [PMID: 29682367 PMCID: PMC5842720 DOI: 10.1155/2018/4378310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/07/2018] [Indexed: 11/17/2022] Open
Abstract
The term “idiopathic erythrocytosis (IE)” is applied to those cases where a causal clinical or pathological event cannot be elucidated and likely reflects a spectrum of underlying medical and molecular abnormalities. The clinical course of a patient with IE is described manifesting as a persistent erythrocytosis with a low serum erythropoietin level, mild eosinophilia, and with evidence of a thrombotic event. The patient subsequently developed a myelodysplasic syndrome (MDS) and acute myeloid leukemia (AML), an event not observed in erythrocytosis patients other than those with polycythemia vera (PV). Application of a next-generation sequencing (NGS) approach targeted for myeloid malignancies confirmed wild-type JAK2 exons 12–15 and identified a common SH2B3 W262R single-nucleotide polymorphism associated with the development of hematological features of myeloproliferative neoplasms (MPNs). Further NGS analysis detected a CBL L380P mutated clone expanding in parallel with the development of MDS and subsequent AML. Despite the absence of JAK2, MPL exon 10, or CALR exon 9 mutations, a similarity with the disease course of PV/MPN was evident. A clonal link between the erythrocytosis and AML could be neither confirmed nor excluded. Future molecular identification of the mechanisms underlying IE is likely to provide a more refined therapeutic approach.
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