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Tokgoz H, Caliskan U, Yüksekkaya HA, Kucukkaya R. Essential thrombocythemia with Mpl W515 K mutation in a child presenting with Budd-Chiari syndrome. Platelets 2015; 26:805-8. [PMID: 25970554 DOI: 10.3109/09537104.2015.1041900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Essential thrombocythemia (ET) is an extremely rare childhood disorder characterised by clonal expansion of megakaryocytic lineage in bone marrow, leading to a persistent increase in the number of circulating thrombocytes and thus increased risk for thrombotic and haemorrhagic events. The molecular mechanisms of ET are not fully understood. Most children with ET have the JAK2 V617F somatic mutation; however, another mutation, involving a W to L or K substitution at Mpl codon 515, was reported in a small proportion of adult ET patients that is extremely rare in children. Herein, we describe a Mpl W515K somatic mutation in a paediatric case of ET who presented with Budd-Chiari syndrome. No paediatric patient harbouring a Mpl W515K mutation has been previously reported.
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Affiliation(s)
- Huseyin Tokgoz
- a Department of Pediatric Haematology, Meram Medical Faculty , Necmettin Erbakan University , Konya , Turkey
| | - Umran Caliskan
- a Department of Pediatric Haematology, Meram Medical Faculty , Necmettin Erbakan University , Konya , Turkey
| | - Hasan Ali Yüksekkaya
- b Department of Pediatric Gastroenterology, Meram Medical Faculty , Necmettin Erbakan University , Konya , Turkey , and
| | - Reyhan Kucukkaya
- c Department of Internal Medicine , Bilim University Medicine Faculty , Istanbul , Turkey
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Abstract
Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study.
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Bertrand A, Heissat S, Caron N, Viremouneix L, Pracros JP, Javouhey E, Lachaux A, Mialou V. [Deep vein thrombosis revealing myeloproliferative syndrome in two adolescents]. Arch Pediatr 2014; 21:497-500. [PMID: 24709317 DOI: 10.1016/j.arcped.2014.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/05/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
Deep vein thrombosis occurs in 30% of patients with essential thrombocythemia, but rarely at initial diagnosis. We report two pediatric patients with essential thrombocythemia revealed by atypical deep vein thrombosis. First, a 16-year-old girl presented Budd-Chiari syndrome revealed by a hemorrhagic shock. Clinical exam revealed isolated splenomegaly. A search for thrombophilia found a factor V Leiden homozygous mutation and a Jak2 mutation. Bone marrow biopsy confirmed the diagnosis of a myeloproliferative disorder. The second case, a 17-year-old girl, had a routine examination by her physician that revealed splenomegaly. Ultrasonography displayed thrombus in the splenic and portal vein. An isolated Jak2 mutation was found and a myeloproliferative disorder was confirmed by bone marrow biopsy. The diagnosis of myeloproliferative disorder was made in both patients presenting atypical venous thrombosis with a Jak2 mutation and confirmed by bone marrow biopsy. These initial presentations of myeloproliferative disorders are rare in childhood and possibly underdiagnosed.
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Affiliation(s)
- A Bertrand
- Institut d'hématologie et d'oncologie pédiatrique, 2, place Joseph-Renault, 69008 Lyon, France.
| | - S Heissat
- Gastro-entérologie, hôpital-Femme-Mère Enfant, 69500 Bron, France
| | - N Caron
- Urgences Pédiatriques, CHU d'Estaing, Clermont-Ferrand, France
| | | | - J-P Pracros
- Radiologie, hôpital Femme-Mère-Enfant, Lyon, France
| | - E Javouhey
- Réanimation pédiatrique, hôpital Femme-Mère-Enfant, Lyon, France
| | - A Lachaux
- Gastro-entérologie, hôpital-Femme-Mère Enfant, 69500 Bron, France
| | - V Mialou
- Banque de tissus et cellules, établissement français du sang, hôpital Édouard-Herriot, Lyon, France
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Idiopathic myelofibrosis in children: primary myelofibrosis, essential thrombocythemia, or transient process? J Pediatr Hematol Oncol 2013; 35:559-65. [PMID: 23799525 DOI: 10.1097/mph.0b013e31829cdea0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report 3 pediatric cases of primary/idiopathic myelofibrosis (PMF/IMF). Two cases exhibited clinical courses not typically observed in adult patients in whom this process is much more common. One of these cases exhibited spontaneous clinical and bone marrow resolution, whereas the other case achieved near resolution of myelofibrosis in response to cytoreductive therapy alone. However, the third case of IMF that met diagnostic criteria for essential thrombocythemia with a JAK2V617F mutation had central venous thrombosis that resulted in blindness. PMF/IMF, a rare finding in children, does not seem to portend the same level of risk as seen in adults with the same process, thus less aggressive management may be appropriate. However, delayed diagnosis of mutation-associated PMF or essential thrombocythemia can lead to devastating consequences. We review the literature and discuss the complexities surrounding diagnosis, risk stratification, and management of pediatric PMF/IMF.
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Fu R, Zhang L, Yang R. Paediatric essential thrombocythaemia: clinical and molecular features, diagnosis and treatment. Br J Haematol 2013; 163:295-302. [PMID: 24032343 DOI: 10.1111/bjh.12530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The incidence of essential thrombocythaemia (ET) in children (age ≤18 years) is extremely low. The natural course of the disorder in children has not been clarified. The rarity of patients and the variability of tested parameters make it difficult to draw any definitive conclusion in pathogenesis and diagnosis of paediatric ET. What makes the onset of thrombocytosis earlier in children is still uncertain. A diagnostic algorithm for paediatric ET has not been established, and current risk stratification used to guide therapeutic decisions in adults has not been validated in children. Vascular complications and transformation to myelofibrosis and leukaemia in this special entity have been reported, suggesting that ET in children is not an entirely benign disease. The crucial question is how to identify patients who are at high risk of complications and need treatment. There are insufficient data to recommend a specific agent in children. The purpose of this review is to outline the most recent progress in paediatric ET and to help with understanding the clinical course, molecular features, diagnosis and treatment strategies in this special group.
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Affiliation(s)
- Rongfeng Fu
- State Key Laboratory of Experimental Haematology, Institute of Haematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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Abstract
Thrombocytosis is a common finding and is a frequent cause of referral for further investigation. The MPL Baltimore (Lys39Asn) mutation has been reported as a cause of thrombocytosis in 7% of African Americans. We describe an 11-month-old Ethiopian Jewish boy referred for evaluation of thrombocytosis who was found to be homozygous for MPL Baltimore. So far, there is no indication whether patients with thrombocytosis who have this mutation, particularly homozygotes, are at increased risk of thrombotic or hemorrhagic complications. Nevertheless, this entity should be considered in the differential diagnosis of every patient with thrombocytosis, particularly those of African origin.
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Two cases of pediatric essential thrombocythemia managed effectively with hydroxyurea. Int J Hematol 2012; 96:810-3. [PMID: 23054653 DOI: 10.1007/s12185-012-1193-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 09/21/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Thrombocytosis is common in infancy and childhood. Essential thrombocythemia (ET), a myeloproliferative disorder, is a much less common cause of thrombocytosis in childhood. We report two cases of essential thrombocythemia in 5- and 10-year-old children, who presented with platelet counts of more than 1,000,000/mm(3). Treatment is not recommended for ET in an asymptomatic patient in the absence of bleeding or thrombosis and a platelet count <1,500,000/mm(3). Our first case had platelets >1,500,000/mm(3), and a second child was symptomatic with recurrent headache. Both responded well to therapy with hydroxyurea (dose 15-30 mg/kg/day) and tolerated it well.
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Abstract
Essential thrombocytosis (ET) is rare in children, sometimes difficult to be distinguished from secondary thrombocytosis. This report concerns 2 children with extreme thrombocytosis of 4100 × 10(9)/L and 1644 × 10(9)/L with partial and complete remission at 3 months and 4 years from diagnosis, with a follow-up of 4 and 17 years, respectively, with no cytoreduction therapy. Diagnosis of ET was suggested according to accepted criteria. However, spontaneous remission of the thrombocytosis argues for the diagnosis of secondary thrombocytosis. These patients highlight the complexity of distinguishing childhood ET from secondary thrombocytosis and the need for cautious personalized decision on cytoreduction therapy.
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Affiliation(s)
- Shraga Aviner
- Department of Pediatrics, Barzilai Medical Center, Ashkelon, Israel.
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Teofili L, Larocca LM. Advances in understanding the pathogenesis of familial thrombocythaemia. Br J Haematol 2011; 152:701-12. [DOI: 10.1111/j.1365-2141.2010.08500.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Teofili L, Giona F, Torti L, Cenci T, Ricerca BM, Rumi C, Nunes V, Foà R, Leone G, Martini M, Larocca LM. Hereditary thrombocytosis caused by MPLSer505Asn is associated with a high thrombotic risk, splenomegaly and progression to bone marrow fibrosis. Haematologica 2009; 95:65-70. [PMID: 19713221 DOI: 10.3324/haematol.2009.007542] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED Background The MPL(Ser505Asn) mutation has been reported to be a cause of hereditary thrombocythemia. Recently, we detected this mutation in a large proportion of children with familial thrombocythemia, suggesting that in Italy the incidence of MPL(Ser505Asn) mutation could be underestimated. DESIGN AND METHODS We extended the search for this mutation to all patients with essential thrombocythemia who had a positive family history for thrombocytosis or essential thrombocythemia. We identified eight Italian families positive for the MPL(Ser505Asn) mutation. Clinical and hematologic data were available for members of seven families, including 21 patients with a proven mutation and 20 relatives with thrombocytosis. RESULTS Fifteen major thrombotic episodes, nine of which were fatal, were recorded among 41 patients. The thrombotic manifestation was stroke in four cases, myocardial infarction in seven cases, fetal loss in two cases, deep vein thrombosis of the leg in one case and Budd Chiari syndrome in one case. Almost all patients over 20 years old had splenomegaly and bone marrow fibrosis, while these were rarely observed in patients under 20 years old, suggesting that these manifestations are associated with aging. Finally, the life expectancy of family members with thrombocytosis was significantly shorter than that of members without thrombocytosis (P=0.003). Conclusions Patients with familial thrombocytosis caused by a MPL(Ser505Asn) mutation have a high risk of thrombosis and, with aging, develop splenomegaly and bone marrow fibrosis, significantly affecting their life expectancy.
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Abstract
Thrombocytosis in childhood is not rare but essential thrombocythemia is an extremely rare myeloproliferative disorder in childhood. The authors report a case of essential thrombocythemia in an 8-year-old boy who was diagnosed during further evaluation of an incidental finding of thrombocythemia in a school health examination.
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Affiliation(s)
- Jayoung Hwang
- The Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Robins EB, Niazi M. Essential thrombocythemia in a child with elevated thrombopoietin concentrations and skeletal anomalies. Pediatr Blood Cancer 2008; 50:859-61. [PMID: 17455310 DOI: 10.1002/pbc.21218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Essential thrombocythemia is a rare myleoproliferative disorder in pediatrics. This myleoproliferative disorder is characterized by excessive proliferation of megakaryocytes and sustained elevation of platelet count. Reactive thrombocytosis is a more common cause of elevated platelet counts among children. We describe a 2-year-old child with essential thrombocythemia, skeletal anomalies, and elevated thrombopoietin concentrations. The child's mother was also subsequently diagnosed with essential thrombocythemia and had elevated thrombopoietin concentrations. Chromosomal studies on the mother, child and other family members were normal.
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Affiliation(s)
- Edwin B Robins
- Department of Pediatrics Hematology/Oncology, Bronx Lebanon Hospital Center, Bronx, New York, USA.
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Szegedi I, Benko I, Mero G, Prinzinger A, Kappelmayer J, Kiss C. Long-lasting partial remission by Interferon-alpha treatment in a child with essential thrombocythemia. Pediatr Blood Cancer 2007; 49:744-7. [PMID: 16421912 DOI: 10.1002/pbc.20744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Essential thrombocythemia (ET) is a clonal myeloproliferative disorder characterized by sustained thrombocytosis, isolated hyperplasia of megakaryocytic lineage, and association with thrombotic or bleeding episodes. It is extremely rare in childhood and frequently presents without evident clinical signs. We describe a 3-year-old girl with severe headache and dizziness suffering from ET, who was treated with Interferon-alpha-2a (IFN) based on the potent effect of this agent to inhibit myeloid colonies induced by phytohemagglutinin A stimulated leukocyte conditioned medium (PHA-LCM). Bone-marrow-derived mononuclear cells of this patient did not exhibit spontaneous colony formation but responded to recombinant human (rh) erythropoietin (EPO), rh granulocyte-colony stimulating factor (G-CSF), granulocyte-macrophage (GM)-CSF, and stem-cell factor in addition to PHA-LCM. After 65 months of in vivo IFN treatment, the patient experienced a sustained partial remission with platelet counts varying between 400 and 600 x 10(3)/microl.
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Affiliation(s)
- István Szegedi
- Department of Pediatrics, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
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El-Moneim AA, Kratz CP, Böll S, Rister M, Pahl HL, Niemeyer CM. Essential versus reactive thrombocythemia in children: retrospective analyses of 12 cases. Pediatr Blood Cancer 2007; 49:52-5. [PMID: 17171694 DOI: 10.1002/pbc.21128] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Essential thrombocythemia (ET) rarely occurs in the pediatric population and little is known about the clinical course and the molecular characteristics. PROCEDURE In this retrospective multi-institutional study we examine the clinical, hematological, and molecular features of 12 children aged 5-16 years with thrombocytosis and a suspected diagnosis of ET. RESULTS Median follow-up was 59 months (range 10-72). Seven patients presented with clinical symptoms potentially related to thrombocytosis. The remaining five patients were diagnosed incidentally. Median platelet count at diagnosis was 1,325 x 10(9)/L (range 600-3,050). In 11 out of 12 cases bone marrow morphology was consistent with ET, the remaining patient had chronic idiopathic myelofibrosis. Cytogenetic analyses were normal in all studied cases and only one out of nine analyzed cases harbored a JAK(V617F) allele. Within 6 months after initial presentation one patient who was initially asymptomatic developed thrombosis and another patient had mild bleeding. Eight patients were treated with acetylsalicylic acid, one patient received hydroxyurea, and two patients received anagrelide. At last follow-up, all patients were alive and none had developed leukemia. Five patients experienced hematological remission. Two children had not received any therapy. During the course of their disease, nine patients developed symptoms possibly attributable to an elevated platelet count. CONCLUSIONS In JAK2 mutation negative cases, long-term follow-up is helpful to distinguish between primary and secondary thrombocytosis. Secondary cases are not associated with organomegaly but may present with unspecific symptoms. Indications for treatment in children remain unclear.
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Affiliation(s)
- Abeer Abd El-Moneim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University of Freiburg, Germany
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Papageorgiou T, Theodoridou A, Kourti M, Nikolaidou S, Athanassiadou F, Kaloutsi V. Childhood essential thrombocytosis. Pediatr Blood Cancer 2006; 47:970-1. [PMID: 16628554 DOI: 10.1002/pbc.20868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lackner H, Urban C, Benesch M, Moser A, Sovinz P, Schwinger W, Dornbusch HJ. Long-term use of anagrelide in the treatment of children with essential thrombocythemia. Eur J Haematol 2006; 77:358-9. [PMID: 16856926 DOI: 10.1111/j.1600-0609.2006.00719.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
This review summarizes current data on the pathomechanisms and clinical aspects of primary and secondary thrombocytosis in childhood. Primary thrombocytosis is extremely rare in childhood, mostly diagnosed at the beginning of the second decade of life. As in adults, the criteria of the Polycythemia Vera Group are appropriate to diagnose primary thrombocytosis. The pathomechansims of non-familial forms are complex and include spontaneous formation of megakaryopoietic progenitors and increased sensitivity to thrombopoietin (Tpo). Familial forms can be caused by mutations in Tpo or Tpo receptor (c-mpl) genes. These mutations result in overexpression of Tpo, sustained intracellular signalling or disturbed regulation of circulating Tpo. Treatment of primary thrombocytosis is not recommended if platelet counts are <1500/nl and bleeding or thrombosis did not occur in patient's history. In severe cases, decision on treatment should weigh potential risks of treatment options (hydroxyurea, anagrelide) against expected benefits for preventing thrombosis or haemorrhage. Secondary thrombocytosis is frequent in children, in particular in the first decade of life. Hepatic Tpo production is stimulated in acute response reaction to a variety of disorders. Thrombosis prophylaxis is not required, even at platelet counts >1000/nl, except for cases with additional prothrombotic risk factors.
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Affiliation(s)
- Christof Dame
- Department of Neonatology, Charité- University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany.
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Jaime-Perez JC, Gomez-Almaguer D. Platelet refractoriness to classical agonists in a child with essential thrombocythemia. Platelets 2005; 16:61-2. [PMID: 15763898 DOI: 10.1080/09537100400007424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Essential thrombocythemia is a rare disease during childhood. Platelet morphological abnormalities are frequent and defects in platelet function tests, mainly hypoaggregation, occur. MATERIALS AND METHODS An incidental diagnosis of essential thrombocythemia was established in a 9-year-old boy with a platelet count of 2050 x 10(9)/l. His platelets were studied for aggregation defects with four classical agonists employing optical aggregometry. RESULTS Aggregation ranged from 5% for adrenaline, 8% for collagen, 12% for ristocetin, to 25% with adenosine diphosphate, followed by complete disaggregation. CONCLUSION Platelet refractoriness to classical agonists, probably compounded by platelet GPIb deficiency, was documented. The differential diagnosis is discussed.
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Hankins J, Naidu P, Rieman M, Wang W, Kaushansky K, Rodriguez-Galindo C. Thrombocytosis in an infant with high thrombopoietin concentrations. J Pediatr Hematol Oncol 2004; 26:142-5. [PMID: 14767209 DOI: 10.1097/00043426-200402000-00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with essential thrombocythemia (ET) usually have normal thrombopoietin (TPO) concentrations because of negative feedback from thrombocytosis. TPO mutations in familial ET cases result in increased translation efficiency with excessive TPO stimulation and thrombocytosis. The authors describe an infant with a high platelet count (1300 x 103/mm3) and an elevated TPO concentration who was successfully treated with anagrelide. Sequencing of TPO revealed no genetic cause. This case may represent a case of atypical ET in which thrombocytosis results from TPO stimulation rather than clonal proliferation. Measuring TPO concentrations may be warranted for children with unexplained extreme thrombocytosis.
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Affiliation(s)
- Jane Hankins
- Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Abstract
Essential thrombocythemia is a distinct clinical entity within the spectrum of myeloproliferative disorders. There is as yet no pathognomonic diagnostic test, and patients who currently fall into the category of essential thrombocythemia are likely to be heterogeneous. This article discusses diagnostic criteria, clinical features, prognosis, and management.
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Affiliation(s)
- Claire N Harrison
- Department of Haematology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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Lecompte T, Lasne D. [Delivery, epidural analgesia and essential thrombocythaemia: evaluation of platelet function and haemorrhagic risk]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:396-8. [PMID: 12831964 DOI: 10.1016/s0750-7658(03)00135-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Florensa L, Zamora L, Besses C, Ortega JJ, Bastida P, Toll T, Mayayo P, Espinet B, Solé F, Serrano S, Woessner S. Cultures of myeloid progenitor cells in pediatric essential thrombocythemia. Leukemia 2002; 16:1876-7. [PMID: 12200712 DOI: 10.1038/sj.leu.2402574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2002] [Accepted: 03/28/2002] [Indexed: 11/08/2022]
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Greist A. The role of blood component removal in essential and reactive thrombocytosis. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2002; 6:36-44. [PMID: 11886575 DOI: 10.1046/j.1526-0968.2002.00394.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
An elevated platelet count is now a common finding in both hospitalized and ambulatory patients with the advent of automated complete blood cell counters. Clinicians may be called upon to make a distinction between a reactive process and a primary hematologic disorder as the cause of a thrombocytosis and to determine whether treatment is indicated. Essential thrombocythemia and other myeloproliferative disorders may present with marked increases in the platelet counts and may be associated with thrombohemorrhagic complications. Reactive thrombocytosis can be caused by iron deficiency and a variety of inflammatory conditions, infections, malignancy, bleeding or hemolysis, splenectomy, and drugs. Acute therapy for all of these disorders has included blood component removal, specifically plateletpheresis. The role of plateletpheresis in current management of thrombocytosis is considered, based on current knowledge of pathophysiology and a review of the literature.
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Affiliation(s)
- Anne Greist
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana 46202, USA
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Abstract
Thrombocytosis is caused by three major pathophysiological mechanisms: (1) reactive or secondary thrombocytosis; (2) familial thrombocytosis; and (3) clonal thrombocytosis, including essential thrombocythemia and related myeloproliferative disorders. Recent work has begun to elucidate the abnormal megakaryocytopoiesis of essential thrombocythemia, which is associated with paradoxically elevated plasma levels of thrombopoietin. The clonal nature of all cases of essential thrombocythemia has been challenged. Thrombotic complications are the major causes of morbidity and mortality in this disease. Indications for platelet cytoreduction and antiplatelet therapy, as well as complications of treatment, are being clarified.
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Affiliation(s)
- A I Schafer
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
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