1
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Raza S, Khan J, Shah AM, Khan M. Myocardial infarction in young individual: A case report of polycythemia vera-induced acute inferior wall myocardial infarction. SAGE Open Med Case Rep 2024; 12:2050313X241253741. [PMID: 38741603 PMCID: PMC11089942 DOI: 10.1177/2050313x241253741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Acute coronary syndrome is commonly associated with traditional cardiovascular risk factors such as smoking, hypertension, diabetes, and hyperlipidemia. Myocardial infarction in a young person presents a significant challenge because its etiology is least likely associated with atherosclerosis. Polycythemia vera refers to one of the rare causes of myocardial infarction, which involves enhanced erythrocyte levels, leukocytosis, thrombocytosis, splenomegaly, and a greater chance of vascular occlusion due to clotting in coronary arteries. A 22-year-old male from Pakistan, Asia without typical risk factors, presented with severe chest pain. Electrocardiography indicated acute inferior wall myocardial infarction, and streptokinase was administered. Subsequent investigations confirmed polycythemia vera. Treatment with hydroxyurea and aspirin was initiated, whereas normal coronary arteries in CT coronary angiogram were observed. This case highlights polycythemia vera's rare role in young individuals' heart attacks without known risk factors, emphasizing the need for early detection and specialized treatments involving hematologists to prevent future thrombotic episodes.
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Affiliation(s)
- Sarmad Raza
- Cardiology Unit, Mardan Medical Complex, Bacha Khan Medical College, Mardan, KP, Pakistan
| | - Jehandad Khan
- Cardiology Unit, Mardan Medical Complex, Bacha Khan Medical College, Mardan, KP, Pakistan
| | - Aresha Masood Shah
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Maaz Khan
- Diagnostic Radiology (CMH Abbottabad), Gomal Medical College, Dera Ismail Khan, KP, Pakistan
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2
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Duran Luciano P, Sabella-Jiménez V. ST-Segment Elevation Myocardial Infarction and Bleeding Complications in JAK2-Negative Polycythemia. Tex Heart Inst J 2023; 50:e238148. [PMID: 37872693 PMCID: PMC10658142 DOI: 10.14503/thij-23-8148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Thrombotic and bleeding complications are major causes of morbidity and mortality in patients with polycythemia vera, who predominantly present with an alteration in the JAK2 gene. Because of their hypercoagulable state and risk of hemorrhage, patients with polycythemia vera who present with an acute myocardial infarction pose a challenge to physicians. This case report describes the presentation and treatment of a Hispanic patient with JAK2 V617F-negative primary polycythemia who developed cardiac arrest and ST-segment elevation myocardial infarction owing to complete occlusion of the left anterior descending artery as well as bleeding complications and postmyocardial pericarditis.
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Affiliation(s)
- Priscilla Duran Luciano
- Department of Cardiology, Albert Einstein College of Medicine, Bronx, New York
- The William J. Harrington Medical Training Program for Latin America and the Caribbean, Miller School of Medicine, University of Miami, Miami, Florida
| | - Vanessa Sabella-Jiménez
- The William J. Harrington Medical Training Program for Latin America and the Caribbean, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
- Department of Medicine, Universidad del Norte, Barranquilla, Colombia
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3
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Guleken Z, Ceylan Z, Aday A, Bayrak AG, Hindilerden İY, Nalçacı M, Jakubczyk P, Jakubczyk D, Depciuch J. FTIR- based serum structure analysis in molecular diagnostics of essential thrombocythemia disease. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 245:112734. [PMID: 37295134 DOI: 10.1016/j.jphotobiol.2023.112734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Essential thrombocythemia (ET) reflects the transformation of a multipotent hematopoietic stem cell, but its molecular pathogenesis remains obscure. Nevertheless, tyrosine kinase, especially Janus kinase 2 (JAK2), has been implicated in myeloproliferative disorders other than chronic myeloid leukaemia. FTIR analysis was performed on the blood serum of 86 patients and 45 healthy volunteers as control with FTIR spectra-based machine learning methods and chemometrics. Thus, the study aimed to determine biomolecular changes and separation of ET and healthy control groups illustration by applying chemometrics and ML techniques to spectral data. The FTIR-based results showed that in ET disease with JAK2 mutation, there are alterations in functional groups associated with lipids, proteins and nucleic acids significantly. Moreover, in ET patients the lower amount of proteins with simultaneously higher amount of lipids was noted in comparison with the control one. Furthermore, the SVM-DA model showed 100% accuracy in calibration sets in both spectral regions and 100.0% and 96.43% accuracy in prediction sets for the 800-1800 cm-1 and 2700-3000 cm-1 spectral regions, respectively. While changes in the dynamic spectra showed that CH2 bending, amide II and CO vibrations could be used as a spectroscopy marker of ET. Finally, it was found a positive correlation between FTIR peaks and first bone marrow fibrosis degree, as well as the absence of JAK2 V617F mutation. The findings of this study contribute to a better understanding of the molecular pathogenesis of ET and identifying biomolecular changes and may have implications for early diagnosis and treatment of this disease.
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Affiliation(s)
- Zozan Guleken
- Department of Physiology, Faculty of Medicine, Gaziantep, Islam, Science and Technology University, 27220, Gaziantep, Turkey.
| | - Zeynep Ceylan
- Samsun University, Faculty of Engineering, Department of Industrial Engineering, Turkey
| | - Aynur Aday
- Istanbul University, Faculty of Medicine, Department of Internal Medicine, Division of Medical Genetics, Turkey
| | - Ayşe Gül Bayrak
- Istanbul University, Faculty of Medicine, Department of Internal Medicine, Division of Medical Genetics, Turkey
| | - İpek Yönal Hindilerden
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Turkey
| | - Meliha Nalçacı
- Istanbul University Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Turkey
| | | | - Dorota Jakubczyk
- Faculty of Mathematics and Applied Physics, Rzeszow University of Technology, Powstancow Warszawy 12, PL-35959 Rzeszow, Poland
| | - Joanna Depciuch
- Institute of Nuclear Physics, PAS, 31342 Krakow, Poland; Department of Biochemistry and Molecular Biology, Medical University of Lublin, 20-093 Lublin, Poland
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4
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In silico multiscale drug design to discover key structural features of potential JAK2 inhibitors. Future Med Chem 2022; 14:1297-1308. [PMID: 36043391 DOI: 10.4155/fmc-2022-0124] [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: 11/17/2022] Open
Abstract
Background: JAK2 inhibitors have been proposed as a new therapeutic option for thalassemia therapy. The objective of this study was to discover the key structural features for improving 2-aminopyrimidine derivatives as potential JAK2 inhibitors. Materials & methods: Quantitative structure-activity relationship (QSAR) approaches (hologram QSAR and comparative molecular similarity indices analysis), molecular dynamics simulations, binding energy calculations and pharmacokinetic predictions were employed. Results: Reliable QSAR models, binding mode and binding interactions of JAK2 inhibitors were obtained and these obtained results were used as the key information for rational design of highly potent JAK2 inhibitors. Conclusion: The concept of new potential JAK2 inhibitors integrated from the obtained results was proved, producing two newly designed compounds, D01 and D02, with potential for use as JAK2 inhibitors.
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5
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Genetic Knock-out of TNFR1 and TNFR2 in a JAK2-V617F Polycythemia Vera Mouse Model. Hemasphere 2022; 6:e717. [PMID: 35449791 PMCID: PMC9015207 DOI: 10.1097/hs9.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
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6
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Bohiltea RE, Niculescu-Mizil E, Mihai BM, Furtunescu F, Ducu I, Munteanu O, Georgescu TA, Grigoriu C. Polycythemia vera in pregnancy represents a challenge for a multidisciplinary collaboration: A case report and literature review. Exp Ther Med 2021; 23:19. [PMID: 34815771 DOI: 10.3892/etm.2021.10941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/24/2021] [Indexed: 01/10/2023] Open
Abstract
Polycythemia vera (PV) is a rare chronic myeloproliferative neoplasm which represents an additional thrombotic factor in pregnancy. PV may be difficult to diagnose, particularly as its incidence is extremely uncommon among young women. The main diagnostic method involves a bone marrow biopsy, and high hemoglobin and platelet counts are usually indicative of the condition, after excluding other more frequent pathologies. PV is associated with a high risk of thrombosis, particularly in pregnancy, and requires anti-platelet treatment. At present, only a limited number of PV cases in pregnancy have been reported in the literature, at least to the best of our knowledge, with the largest case series being a retrospective study that included 25 pregnancies in 15 women. The present study describes the case of a patient diagnosed with JAK2-positive PV and also discusses this rare condition with particular focus on the following: i) The management of PV in pregnancy along with the additional pathologies in this specific case; and ii) the particularities of the pregnancy course. By identifying women suffering from PV superimposed by other possible procoagulant factors and applying the latest standard in healthcare, fetal and maternal prognosis may be significantly improved.
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Affiliation(s)
- Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Obstetrics and Gynecology, Life Memorial Hospital, 012244 Bucharest, Romania
| | | | - Bianca Margareta Mihai
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Ionita Ducu
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Octavian Munteanu
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Tiberiu Augustin Georgescu
- Department of Pathology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Corina Grigoriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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7
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Sassi H, Menif S, Ammar SB, Farrah A, Othmen HBH, Amouri H. JAK2 p.(V617F) mutation in Tunisian myeloproliferative neoplasms and its genotype-phenotype correlation. Pan Afr Med J 2021; 39:194. [PMID: 34603575 PMCID: PMC8464212 DOI: 10.11604/pamj.2021.39.194.28307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/07/2021] [Indexed: 11/11/2022] Open
Abstract
Myeloproliferative neoplasms (MPNs) comprise polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF). The relationship between JAK2 p.(V617F) mutation and MPNs was first described in 2005. The purpose of this study was to determine the prevalence of JAK2 p.(V617F) mutation in Tunisian patients assessed for MPNs and try to set a genotype-phenotype correlation. A retrospective study was conducted between January 2015 and April 2019. We collected the clinical data of all patients with MPNs suspicion or atypical splanchnic vein thrombosis (SVT). JAK2 p.(V617F) mutation was detected by allele specific real-time quantitative fluorescence PCR (AS-qPCR). We gathered 974 patients who underwent molecular analysis, 55.5% of them were male and 44.5% were female. The median age of all studied patients was 56 years. JAK2 p.(V617F) was found in 349 (35.8%) of total enrolled cases. It was reported in 44%, 37%, 29% and 25% of all patients diagnosed as having respectively ET, PV, PMF and atypical SVT. JAK2 p.(V617F) was negative in 62.2% of patients addressed for suspicion of PV. There was a significant positive correlation between the JAK2 p.(V617F) mutation status, age, gender, white blood cell counts and platelet counts. To our best knowledge, this is the first vast investigation of JAK2 p.(V617F) variant in Tunisia and North Africa with the lowest mutation rate in entire cohort and MPNs subgroups, underlying a specific presentation of this mutation. It is considered as an essential marker of MPNs’ diagnosis and prognosis and is associated with differences in the phenotype of these disorders, helpful for the follow-up of these patients.
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Affiliation(s)
- Hela Sassi
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University Tunis El Manar, 1002, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, 1006, Tunis, Tunisia
| | - Samia Menif
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University Tunis El Manar, 1002, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, 1006, Tunis, Tunisia
| | - Safa Ben Ammar
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University Tunis El Manar, 1002, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, 1006, Tunis, Tunisia
| | - Ahlem Farrah
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University Tunis El Manar, 1002, Tunis, Tunisia
| | - Hend Ben Hadj Othmen
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University Tunis El Manar, 1002, Tunis, Tunisia
| | - Hassiba Amouri
- Laboratory of Molecular and Cellular Hematology, Pasteur Institute of Tunis, University Tunis El Manar, 1002, Tunis, Tunisia
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8
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Pedersen OB, Hvas AM, Ommen HB, Kristensen SD, Grove EL. Lower Antiplatelet Effect of Aspirin in Essential Thrombocythemia than in Coronary Artery Disease. TH OPEN 2021; 5:e230-e238. [PMID: 34235392 PMCID: PMC8255105 DOI: 10.1055/s-0041-1731309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/16/2021] [Indexed: 01/02/2023] Open
Abstract
Background
Patients with essential thrombocythemia (ET) and coronary artery disease (CAD) have increased risk of thromboembolic complications. In addition, a reduced antiplatelet effect of aspirin has been demonstrated in both patient groups. As ET is a platelet disorder, platelets may be more important for the thromboembolic risk in ET than in CAD. We aimed to investigate the antiplatelet effect of aspirin and platelet turnover in ET versus CAD patients.
Methods
We included 48 ET patients and an age-matched group of 48 CAD patients. The effect of aspirin was evaluated by thromboxane B
2
(TXB
2
) levels and platelet aggregation. Platelet turnover was assessed by immature platelet count (IPC) and immature platelet fraction (IPF).
Results
ET patients had reduced effect of aspirin compared with CAD patients, demonstrated by significantly higher TXB
2
levels (median of differences = 22.3 ng/mL,
p
< 0.0001) and platelet aggregation (median of differences = 131.0 AU*min,
p
= 0.0003). Furthermore, ET patients had significantly higher IPC (
p
< 0.0001) and IPF (
p
= 0.0004) than CAD patients.
Conclusion
ET patients have lower 24-hour antiplatelet effect of aspirin than CAD patients. This may be explained by an increased platelet production and turnover counteracting the antiplatelet effect of aspirin. These findings strengthen the rationale for exploring novel antiplatelet regimens in ET patients to reduce the risk of cardiovascular events.
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Affiliation(s)
- Oliver Buchhave Pedersen
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Dalby Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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9
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Rambaldi A, Iurlo A, Vannucchi AM, Martino B, Guarini A, Ruggeri M, von Bubnoff N, De Muro M, McMullin MF, Luciani S, Martinelli V, Nogai A, Rosti V, Ricco A, Bettica P, Manzoni S, Di Tollo S. Long-term safety and efficacy of givinostat in polycythemia vera: 4-year mean follow up of three phase 1/2 studies and a compassionate use program. Blood Cancer J 2021; 11:53. [PMID: 33677466 PMCID: PMC7936975 DOI: 10.1038/s41408-021-00445-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 02/08/2023] Open
Abstract
Polycythemia vera (PV) is a BCR-ABL1-negative myeloproliferative neoplasm (MPN) characterized by excessive proliferation of erythroid, myeloid, and megakaryocytic components in the bone marrow, mainly due to a Janus kinase 2 gene mutation (JAK2V617F). Givinostat, a histone-deacetylase inhibitor that selectively targets JAK2V617F cell growth, has demonstrated good efficacy and safety in three phase 1/2 studies in patients with PV. This manuscript focuses on the 4-year mean (2.8 year median) follow-up of an open-label, long-term study that enrolled 51 patients with PV (out of a total of 54 with MPN) who received clinical benefit from givinostat in these previous studies or on compassionate use, and who continued to receive givinostat at the last effective and tolerated dose. The primary objectives are to determine givinostat's long-term safety and tolerability, and efficacy evaluated by the investigators according to internationally recognized response criteria. During follow-up, only 10% of PV patients reported Grade 3 treatment-related adverse events (AEs), while none had Grade 4 or 5 treatment-related AEs. The overall response rate for the duration of follow-up was always greater than 80% in patients with PV. In conclusion, givinostat demonstrated a good safety and efficacy profile in patients with PV, data supporting long-term use in this population.
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Affiliation(s)
- Alessandro Rambaldi
- Department of Oncology and Hematology University of Milan, and Azienda SocioSanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
| | - Alessandra Iurlo
- Hematology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro M Vannucchi
- Center Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
| | - Bruno Martino
- Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Haematology Unit, Reggio Calabria, Italy
| | - Attilio Guarini
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Marco Ruggeri
- U.O. Haematology, San Bortolo Hospital, Vicenza, Italy
| | - Nikolas von Bubnoff
- Department of Haematology, Oncology and Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Haematology and Oncology, Medical Center, University of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marianna De Muro
- Hematology and Stem Cells Transplantation Unit, Campus Bio-Medico, University Hospital, Rome, Italy
| | | | - Stefania Luciani
- Dipartimento Oncologia-Ematologia, U.O. Complessa Ematologia Clinica, Presidio Ospedaliero "Spirito Santo"- A.S.L. Azienda Sanitaria Locale, Pescara, Italy
| | - Vincenzo Martinelli
- Dipartimento di Medicina Clinica e Chirurgia, Ematologia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Axel Nogai
- Division of Hematology and Oncology at Campus Benjamin Franklin (CBF), Charité, Berlin, Germany
| | - Vittorio Rosti
- Fondazione I.R.C.C.S. Policlinico San Matteo di Pavia, Centro per lo Studio e la Cura della Mielofibrosi, Laboratorio Biochimica, Biotecnologie e Diagnostica Avanzata, Pavia, Italy
| | - Alessandra Ricco
- Azienda Ospedaliero-Universitaria Policlinico Consorziale di Bari, U. O. Ematologia con Trapianto - Ambulatorio, Bari, Italy
| | - Paolo Bettica
- Clinical R&D Department, Italfarmaco S.p.A, Cinisello Balsamo, Italy
| | - Sara Manzoni
- Clinical R&D Department, Italfarmaco S.p.A, Cinisello Balsamo, Italy
| | - Silvia Di Tollo
- Clinical R&D Department, Italfarmaco S.p.A, Cinisello Balsamo, Italy
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10
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Abstract
PURPOSE OF REVIEW Thrombocytosis is common to all myeloproliferative neoplasms (MPN), including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis. Despite the traditionally held belief amongst many clinicians that thrombocytosis correlates with thrombosis risk, there is little evidence in the literature to support that claim. Herein we critically analyze the literature to better understand the relationship between thrombocytosis and risk of thrombosis in MPN. RECENT FINDINGS Both retrospective and prospective studies argue against associations between thrombocytosis and risk of thrombosis in patients with ET and PV. Rather, most studies suggest that the presence of extreme thrombocytosis is instead associated with an increased risk of hemorrhagic events, a paradoxical phenomenon with important clinical implications. Thrombosis risk has a multifactorial set of etiologies in MPNs. While qualitative abnormalities of the platelets may contribute, associations between platelet quantity and thrombosis risk are weak in MPN patients.
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11
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Shoji K, Zen K, Yanishi K, Wakana N, Nakanishi N, Nakamura T, Matoba S. Two effective cases of additional pedal artery angioplasty for severe lower limb ischemia following acute thrombotic artery occlusion with hypercoagulable state diseases. CVIR Endovasc 2020; 3:71. [PMID: 32986148 PMCID: PMC7520864 DOI: 10.1186/s42155-020-00166-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/24/2020] [Indexed: 12/03/2022] Open
Abstract
Background Acute limb ischemia (ALI) and critical limb ischemia (CLI) following ALI are life-threatening diseases. The rare potential causes of ALI include hypercoagulable state diseases, such as antiphospholipid syndrome (APS) and essential thrombocythemia (ET). Hypercoagulability often make revascularization for arterial occlusion, especially associated with infrapopliteal lesions, difficult. This is because the vessels have poor run-off, and elevated peripheral vascular resistance associated with microcirculation failure, due to a high thrombus burden. There is no established treatment for this issue. Case presentation A 45 years-old and a 56 years-old male suffered from thrombotic arterial occlusion as a first manifestation of APS and ET, respectively. Combination therapy with aggressive anti-thrombotic therapy and revascularization, such as endovascular therapy and surgical thrombectomy based on the angiosome concept, was performed. However, the high thrombus burden caused a poor pedal outflow, and significant limb ischemia remained. Additional pedal artery angioplasty was performed to improve residual limb ischemia in each case and provided sufficient blood flow to the foot. Conclusion The pedal artery angioplasty for thrombotic pedal artery occlusion cases, associated with hypercoagulable state diseases, seems to be a treatment option for relieving residual limb ischemia.
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Affiliation(s)
- Keisuke Shoji
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kenji Yanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Noriyuki Wakana
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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12
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Abu-Tineh M, Yassin MA. Extreme Levels of Platelet Count in Essential Thrombocythemia: Management and Outcome, Report of Two Cases. Case Rep Oncol 2020; 13:606-610. [PMID: 32595470 PMCID: PMC7315211 DOI: 10.1159/000507363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022] Open
Abstract
Myeloproliferative neoplasms including essential thrombocythemia (ET) is usually caused by somatic mutations in multiple genes, including the JAK2 (most frequently), CALR gene, and MPL. In rare cases, the disease is caused by other mutations such as THPO or TET2 gene; however, around 10–15% with ET might have triple-negative mutations. Here we present 2 cases of ET who were asymptomatic on diagnoses, but found to have extremely high platelet counts as never reported earlier. The management and treatment plan can be a challenging step. The objective is to draw attention to the early introduction of thrombocytapheresis in the management of such patients given its notable outcomes.
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Affiliation(s)
| | - Mohamed A Yassin
- National Center for Cancer Care and Research, Department of Oncology, Hematology and BMT Section, Hamad Medical Corporation, Doha, Qatar
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13
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Abu-Tineh M, Kassem N, Abdulla MAJ, Ismail OM, Ghasoub R, Aldapt MB, Yassin MA. Outcome of Pregnancy in the Era of Pegylated Interferon Alpha 2a in Females with Essential Thrombocythemia: An Experience from Qatar. Case Rep Oncol 2020; 13:336-340. [PMID: 32308601 PMCID: PMC7154247 DOI: 10.1159/000506447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 01/28/2023] Open
Abstract
Myeloproliferative neoplasms are a diversified group of diseases of the hematopoietic stem cell, such as essential thrombocythemia (ET) and polycythemia vera. They are mainly caused by mutations in the following genes: JAK2, CALR, and MPL. All carry an increased risk to transform into acute leukemia or chronic myelogenous leukemia along with thrombosis and hemorrhagic complications. Treatment of such disorders during pregnancy is a challenging footstep, given the high risk of complications for both the mother and the fetus. Here, we report about two pregnant females with ET that has been treated with pegylated interferon alpha with safe and effective outcome.
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Affiliation(s)
- Mohammad Abu-Tineh
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Nancy Kassem
- National Center for Cancer Care and Research, Department of Pharmacy, HMC, Doha, Qatar
| | - Mohammad Abdul-Jaber Abdulla
- National Center for Cancer Care and Research, Department of Oncology − Hematology and BMT Section −, HMC, Doha, Qatar
| | - Omar Mohammad Ismail
- National Center for Cancer Care and Research, Department of Oncology − Hematology and BMT Section −, HMC, Doha, Qatar
| | - Rola Ghasoub
- National Center for Cancer Care and Research, Department of Pharmacy, HMC, Doha, Qatar
| | - Mahmood B. Aldapt
- National Center for Cancer Care and Research, Department of Oncology − Hematology and BMT Section −, HMC, Doha, Qatar
| | - Mohamed A. Yassin
- National Center for Cancer Care and Research, Department of Oncology − Hematology and BMT Section −, HMC, Doha, Qatar
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14
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Jung SM, Jun H. Recurrent thrombosis of splanchnic and lower extremity arteries with essential thrombocythemia. SAGE Open Med Case Rep 2019; 7:2050313X19880079. [PMID: 31632677 PMCID: PMC6767714 DOI: 10.1177/2050313x19880079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/10/2019] [Indexed: 12/02/2022] Open
Abstract
Essential thrombocythemia is a myeloproliferative neoplasm characterized by
platelet aggregation and thrombosis. Clinically, essential thrombocythemia
increases the risk of both thrombosis and bleeding. Essential thrombocythemia is
more involved in micro- and small-sized arteries than in large arteries. Many
essential thrombocythemia patients exhibit various symptoms, including
microvascular thrombosis with acute coronary disease, digital ischemia, and
transient ischemic attack. This study reports a rare case of recurrent
thrombosis in relatively large vessels including splanchnic, lower extremity
arteries, and aorta in essential thrombocythemia. A 70-year-old woman was
admitted to the emergency room with abdominal pain and fever for a day. The
patient underwent three operations due to recurrent arterial thrombosis of
superior mesenteric, splenic, aorta, and lower extremities. She had recurrent
diarrhea and acute kidney injury because of short bowel syndrome after extensive
bowel resection. In conclusion, essential thrombocythemia patients aged >60
years and who have risk factors such as history of major ischemic events or
severe leukocytosis must be careful of thrombosis of the medium- and large-sized
arteries, including splanchnic and lower extremity arteries.
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Affiliation(s)
- Sung Min Jung
- Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea
| | - Heungman Jun
- Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea
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15
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Grunwald MR, Burke JM, Kuter DJ, Gerds AT, Stein B, Walshauser MA, Parasuraman S, Colucci P, Paranagama D, Savona MR, Mesa R. Symptom Burden and Blood Counts in Patients With Polycythemia Vera in the United States: An Analysis From the REVEAL Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:579-584.e1. [PMID: 31303457 PMCID: PMC8148986 DOI: 10.1016/j.clml.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/14/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Approximately 50% of patients with polycythemia vera (PV) have PV-related symptoms at diagnosis; these symptoms might develop or worsen with time. Symptoms have been shown to negatively affect quality of life and interfere with daily activities. To our knowledge, an analysis to evaluate the relationship between blood count control and symptoms has not been published. PATIENTS AND METHODS The Prospective Observational Study of Patients with Polycythemia Vera in US Clinical Practices (REVEAL; NCT02252159) is a multicenter, noninterventional, nonrandomized prospective observational study of patients with PV in the United States. Patients included were required to have a complete blood count result within 30 days before completing the at-enrollment Myeloproliferative Neoplasm Self-Assessment Form Total Symptom Score (MPN-SAF TSS). Symptom severity was compared between those who had blood count control versus those who did not. RESULTS At the time of enrollment, 1714 patients (94.5%) were being managed with cytoreductive therapy; 468 patients (25.8%) had complete hematologic remission (CHR), 1614 patients (89.0%) had ≥1 controlled blood count, and 1122 patients (61.9%) had ≥2 controlled blood counts. Mean MPN-SAF TSSs were similar across patients in different blood count control groups. Fatigue was the most frequently reported symptom. The severity of individual symptoms, except those of pruritus and night sweats, was not affected by CHR or the number of blood counts that were controlled. CONCLUSION Symptom burden in patients with PV can persist despite control of blood counts, which suggests some discordance between laboratory values and symptom burden. Consequently, regular monitoring of symptom burden should be factored into the assessment of disease control.
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Affiliation(s)
- Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC.
| | - John M Burke
- US Oncology Hematology Research Program, Rocky Mountain Cancer Centers, Aurora, CO
| | - David J Kuter
- Center for Hematology, Massachusetts General Hospital, Boston, MA
| | - Aaron T Gerds
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Brady Stein
- Department of Hematology and Oncology, Northwestern University, Chicago, IL
| | - Mark A Walshauser
- Department of Medical Oncology and Hematology, Cancer Care Specialists of Illinois, Swansea, IL
| | | | | | | | - Michael R Savona
- Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Ruben Mesa
- Department of Hematology and Oncology, The University of Texas Health Science Center, San Antonio, TX
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16
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Mochizuki T, Tanabe K, Saito R, Ota H, Yamamoto Y, Saeki Y, Ohdan H. Perioperative management of polycythemia vera with advanced gastric cancer: A case report. Int J Surg Case Rep 2019; 58:224-227. [PMID: 31112910 PMCID: PMC6527945 DOI: 10.1016/j.ijscr.2019.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/11/2022] Open
Abstract
We report a case involving operation for gastric cancer after treatment for PV. Control of WBC and Plt counts during the perioperative period led to good results. Perioperative management for PV is important for complication-free surgery. Careful follow up should be performed for gastric cancer and PV recurrence.
Introduction Polycythemia vera (PV) is a chronic myeloproliferative disorder with generally good prognosis. However, thrombotic and cardiovascular complications are among the leading causes of death in patients with PV and sufficiently effective management strategies are yet to be established. We report a case involving operation for gastric cancer in a patient being treated for PV. Presentation of case A 73-year-old man was diagnosed as PV on the basis of abnormal laboratory data eight years previously. Three months ago, he was referred to our department for anorexia and melena. The preoperative diagnosis was advanced gastric cancer, Stage IIB. To avoid perioperative thrombotic and hemorrhagic events, low-dose aspirin administration was continued with an additional dose of hydroxyurea. Emergent control was necessary because of the severity of gastric cancer symptoms, including pyloric stenosis and anemia. Distal gastrectomy with D2 lymph node resection was performed. The postoperative course was satisfactory, and the patient is currently doing well without any signs of recurrence or hematological complications. Discussion We described the successful management of a patient being treated for PV who underwent gastrectomy. As mentioned earlier, thrombotic complications and hemorrhage during the perioperative period are the major risk factors in patients with PV. In this case, control of white blood cell and platelet counts during the perioperative period led to good results. Conclusions Perioperative management for PV is important for complication-free surgery. Careful follow up should be performed for gastric cancer and PV recurrence.
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Affiliation(s)
- Tetsuya Mochizuki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuaki Tanabe
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Ryusuke Saito
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Ota
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuji Yamamoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoshihiro Saeki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biochemical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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17
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Windisch R, Pirschtat N, Kellner C, Chen-Wichmann L, Lausen J, Humpe A, Krause DS, Wichmann C. Oncogenic Deregulation of Cell Adhesion Molecules in Leukemia. Cancers (Basel) 2019; 11:E311. [PMID: 30841639 PMCID: PMC6468598 DOI: 10.3390/cancers11030311] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 01/01/2023] Open
Abstract
Numerous cell⁻cell and cell⁻matrix interactions within the bone marrow microenvironment enable the controlled lifelong self-renewal and progeny of hematopoietic stem and progenitor cells (HSPCs). On the cellular level, this highly mutual interaction is granted by cell adhesion molecules (CAMs) integrating differentiation, proliferation, and pro-survival signals from the surrounding microenvironment to the inner cell. However, cell⁻cell and cell⁻matrix interactions are also critically involved during malignant transformation of hematopoietic stem/progenitor cells. It has become increasingly apparent that leukemia-associated gene products, such as activated tyrosine kinases and fusion proteins resulting from chromosomal translocations, directly regulate the activation status of adhesion molecules, thereby directing the leukemic phenotype. These observations imply that interference with adhesion molecule function represents a promising treatment strategy to target pre-leukemic and leukemic lesions within the bone marrow niche. Focusing on myeloid leukemia, we provide a current overview of the mechanisms by which leukemogenic gene products hijack control of cellular adhesion to subsequently disturb normal hematopoiesis and promote leukemia development.
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Affiliation(s)
- Roland Windisch
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Nina Pirschtat
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Christian Kellner
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Linping Chen-Wichmann
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Jörn Lausen
- Institute for Transfusion Medicine and Immunohematology, Johann-Wolfgang-Goethe University and German Red Cross Blood Service, 60528 Frankfurt am Main, Germany.
| | - Andreas Humpe
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital, LMU Munich, 81377 Munich, Germany.
| | - Daniela S Krause
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, 60596 Frankfurt am Main, Germany.
| | - Christian Wichmann
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital, LMU Munich, 81377 Munich, Germany.
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18
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Zhao C, Li Z, Ji L, Ma J, Ge RL, Cui S. PI3K-Akt Signal Transduction Molecules Maybe Involved in Downregulation of Erythroblasts Apoptosis and Perifosine Increased Its Apoptosis in Chronic Mountain Sickness. Med Sci Monit 2017; 23:5637-5649. [PMID: 29176544 PMCID: PMC5713146 DOI: 10.12659/msm.905739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Chronic mountain sickness (CMS) has a higher incidence in the plateau region. The one of its principal characters is excessive erythrocytosis. The PI3K-Akt pathway plays an important role in the process of erythropoiesis, and could downregulate apoptosis by regulating apoptosis-related molecules. In this paper, we explored the change in apoptosis of erythroblasts and the effect of the PI3K-Akt signal pathway on erythroblasts apoptosis in CMS. Material/Methods A total of 22 CMS and 20 non-CMS participants were involved in this study. Bone marrow mononuclear cells were cultured and treated with celecoxib and perifosine in vitro for 72 hours. The apoptotic rate, the mRNA expressions of Akt, Bcl-xl, and caspase-9, and the protein expressions of Akt, p-Akt, Bcl-xl, and caspase-9 were determined by flow cytometry, quantitative RT-PCR, and western-blot technique. Results The apoptotic rate of cultured erythroblasts was lower in the CMS group than in the non-CMS group. It was increased after perifosine intervention. The mRNA and protein expressions of Akt and Bcl-xl were higher and caspase-9 was lower in the CMS group than the non-CMS group. Perifosine induced decreased Bcl-xl mRNA and proteins and p-Akt proteins, and increased caspase-9 mRNA and proteins in vitro. In the CMS group, the hemoglobin concentration was correlated with apoptotic rate negatively and with Bcl-xl mRNA positively in erythroblasts; the erythroblasts apoptotic rate was negatively associated with the Akt mRNA and Bcl-xl mRNA. Conclusion The erythroblasts apoptosis was downregulated and the PI3K-Akt signal pathway appeared to be involved in the mechanism of decreased erythroblasts apoptosis in CMS.
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Affiliation(s)
- Chengyu Zhao
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China (mainland).,Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China (mainland)
| | - Zhanquan Li
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China (mainland).,Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China (mainland)
| | - Linhua Ji
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China (mainland).,Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China (mainland)
| | - Jie Ma
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China (mainland).,Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China (mainland)
| | - Ri-Li Ge
- Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China (mainland)
| | - Sen Cui
- Department of Hematology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China (mainland).,Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China (mainland)
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19
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Cornet N, Vialard F, Mir O, Berveiller P. Is anagrelide safe during pregnancy? J Gynecol Obstet Hum Reprod 2017; 46:697-699. [PMID: 28866127 DOI: 10.1016/j.jogoh.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Affiliation(s)
- N Cornet
- Department of Gynecology and Obstetrics, Poissy-Saint-Germain Hospital, 10, rue du Champ-Gaillard, 78300 Poissy, France
| | - F Vialard
- Department of Cytogenetic, Poissy-Saint-Germain Hospital, 10, rue du Champ-Gaillard, 78300 Poissy, France; GIG - EA 7404, Paris-Saclay University, Montigny-Le-Bretonneux, France
| | - O Mir
- Department of Cancer Medicine, Gustave-Roussy Cancer Campus, Villejuif, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint-Germain Hospital, 10, rue du Champ-Gaillard, 78300 Poissy, France; GIG - EA 7404, Paris-Saclay University, Montigny-Le-Bretonneux, France.
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20
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Myeloproliferative neoplasms and the JAK/STAT signaling pathway: an overview. Rev Bras Hematol Hemoter 2015; 37:348-53. [PMID: 26408371 PMCID: PMC4685044 DOI: 10.1016/j.bjhh.2014.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/19/2014] [Indexed: 01/18/2023] Open
Abstract
Myeloproliferative neoplasms are caused by a clonal proliferation of a hematopoietic progenitor. First described in 1951 as ‘Myeloproliferative Diseases’ and reevaluated by the World Health Organization classification system in 2011, myeloproliferative neoplasms include polycythemia vera, essential thrombocythemia and primary myelofibrosis in a subgroup called breakpoint cluster region-Abelson fusion oncogene-negative neoplasms. According to World Health Organization regarding diagnosis criteria for myeloproliferative neoplasms, the presence of the JAK2 V617F mutation is considered the most important criterion in the diagnosis of breakpoint cluster region-Abelson fusion oncogene-negative neoplasms and is thus used as a clonal marker. The V617F mutation in the Janus kinase 2 (JAK2) gene produces an altered protein that constitutively activates the Janus kinase/signal transducers and activators of transcription pathway and other pathways downstream as a result of signal transducers and activators of transcription which are subsequently phosphorylated. This affects the expression of genes involved in the regulation of apoptosis and regulatory proteins and modifies the proliferation rate of hematopoietic stem cells.
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21
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Santisakultarm TP, Paduano CQ, Stokol T, Southard TL, Nishimura N, Skoda RC, Olbricht WL, Schafer AI, Silver RT, Schaffer CB. Stalled cerebral capillary blood flow in mouse models of essential thrombocythemia and polycythemia vera revealed by in vivo two-photon imaging. J Thromb Haemost 2014; 12:2120-30. [PMID: 25263265 DOI: 10.1111/jth.12738] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Essential thrombocythemia (ET) and polycythemia vera (PV) are myeloproliferative neoplasms (MPNs) that share the JAK2(V617F) mutation in hematopoietic stem cells, leading to excessive production of predominantly platelets in ET, and predominantly red blood cells (RBCs) in PV. The major cause of morbidity and mortality in PV and ET is thrombosis, including cerebrovascular occlusive disease. OBJECTIVES To identify the effect of excessive blood cells on cerebral microcirculation in ET and PV. METHODS We used two-photon excited fluorescence microscopy to examine cerebral blood flow in transgenic mouse models that mimic MPNs. RESULTS AND CONCLUSIONS We found that flow was 'stalled' in an elevated fraction of brain capillaries in ET (18%), PV (27%), mixed MPN (14%) and secondary (non-MPN) erythrocytosis (27%) mice, as compared with controls (3%). The fraction of capillaries with stalled flow increased when the hematocrit value exceeded 55% in PV mice, and the majority of stalled vessels contained only stationary RBCs. In contrast, the majority of stalls in ET mice were caused by platelet aggregates. Stalls had a median persistence time of 0.5 and 1 h in ET and PV mice, respectively. Our findings shed new light on potential mechanisms of neurological problems in patients with MPNs.
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Affiliation(s)
- T P Santisakultarm
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
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22
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Cetin G, Ozkan T, Turgut S, Ali Cikrikcioglu M, Cem Ar M, Ayer M, Unlu A, Celik SR, Sekin Y, Karatoprak C. Evaluation of clinical and laboratory findings with JAK2 V617F mutation as an independent variable in essential thrombocytosis. Mol Biol Rep 2014; 41:6737-42. [DOI: 10.1007/s11033-014-3559-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
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23
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Titmarsh GJ, Duncombe AS, McMullin MF, O'Rorke M, Mesa R, De Vocht F, Horan S, Fritschi L, Clarke M, Anderson LA. How common are myeloproliferative neoplasms? A systematic review and meta-analysis. Am J Hematol 2014; 89:581-7. [PMID: 24971434 DOI: 10.1002/ajh.23690] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Myeloproliferative neoplasms (MPNs) are a heterogeneous group of diseases including polycythemia vera (PV), essential thrombocythemia (ET), and primary(idiopathic) myelofibrosis (PMF). In this systematic review, we provide a comprehensive report on the incidence and prevalence of MPNs across the globe. Electronic databases (PubMed, EMBASE, MEDLINE, and Web of Science) were searched from their inception to August 2012 for articles reporting MPN incidence or prevalence rates. A random effects meta-analysis was undertaken to produce combined incidence rates for PV, ET, and PMF. Both heterogeneity and small study bias were assessed. Thirty-four studies were included. Reported annual incidence rates ranged from 0.01 to 2.61, 0.21 to 2.27, and 0.22 to 0.99 per 100,000 for PV, ET, and PMF, respectively. The combined annual incidence rates for PV, ET, and PMF were 0.84, 1.03, and 0.47 per 100,000. There was high heterogeneity across disease entities (I(2) 97.1-99.8%) and evidence of publication bias for ET and PMF (Egger test, P = 50.007 and P ≤ 0.001, respectively).The pooled incidence reflects the rarity of MPNs. The calculated pooled incidence rates do not reflect MPN incidence across the globe due to the high unexplained heterogeneity. Improved, widespread registration of MPNs would provide better information for global comparison of the incidence and prevalence of MPNs.
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Affiliation(s)
- Glen J. Titmarsh
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
| | - Andrew S. Duncombe
- Department of Haematology; University Hospitals Southampton NHS Foundation Trust; Hampshire United Kingdom
| | - Mary Frances McMullin
- Centre for Cancer Research and Cell Biology; Queen's University Belfast; Belfast Northern Ireland
| | - Michael O'Rorke
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
| | - Ruben Mesa
- Mayo Clinic Cancer Centre; Rochester Arizona
| | - Frank De Vocht
- Centre for Occupational and Environmental Health; The University of Manchester; Manchester United Kingdom
| | - Sarah Horan
- School of Health Sciences; City University London; London United Kingdom
| | - Lin Fritschi
- Western Australian Institute for Medical Research; The University of Western Australia; Perth Australia
| | - Mike Clarke
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
| | - Lesley A. Anderson
- Centre for Public Health; Queen's University Belfast; Belfast Northern Ireland
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24
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The incidence and predictors of thromboembolic events in patients with lung cancer. ScientificWorldJournal 2014; 2014:125706. [PMID: 24574864 PMCID: PMC3918375 DOI: 10.1155/2014/125706] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022] Open
Abstract
Patients with lung cancer experience elevated risk of venous thromboembolism. Cancer patients with thrombosis have a shorter life expectancy and the occurrence of VTE worsens the quality of life and may delay, interrupt, or completely halt the cancer therapy. In a large cohort of lung cancer patients we monitored the incidence of venous thromboembolism and we identified groups of patients with the highest risk of venous thromboembolism suitable for antithrombotic prophylaxis, which could favourably affect their morbidity and mortality.
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25
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Gonzalez-Villalva A, Piñon-Zarate G, Falcon-Rodriguez C, Lopez-Valdez N, Bizarro-Nevares P, Rojas-Lemus M, Rendon-Huerta E, Colin-Barenque L, Fortoul TI. Activation of Janus kinase/signal transducers and activators of transcription pathway involved in megakaryocyte proliferation induced by vanadium resembles some aspects of essential thrombocythemia. Toxicol Ind Health 2014; 32:908-18. [PMID: 24442345 DOI: 10.1177/0748233713518600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vanadium (V) is an air pollutant released into the atmosphere by burning fossil fuels. Also, it has been recently evaluated for their carcinogenic potential to establish permissible limits of exposure at workplaces. We previously reported an increase in the number and size of platelets and their precursor cells and megakaryocytes in bone marrow and spleen. The aim of this study was to identify the involvement of Janus kinase/signal transducers and activators of transcription (JAK/STAT) pathway and thrombopoietin (TPO) receptor, and myeloproliferative leukemia virus oncogene (Mpl), in megakaryocyte proliferation induced by this compound. Mice were exposed twice a week to vanadium pentoxide inhalation (0.02 M) and were killed at 4th, 6th, and 8th week of exposure. Phosphorylated JAK2 (JAK2 ph), STAT3 (STAT3 ph), STAT5, and Mpl were identified in mice spleen megakaryocytes by cytofluorometry and immunohistochemistry. An increase in JAK2 ph and STAT3 ph, but a decrease in Mpl at 8-week exposure was identified in our findings. Taking together, we propose that the morphological findings, JAK/STAT activation, and decreased Mpl receptor induced by V leads to a condition comparable to essential thrombocythemia, so the effect on megakaryocytes caused by different mechanisms is similar. We also suggest that the decrease in Mpl is a negative feedback mechanism after the JAK/STAT activation. Since megakaryocytes are platelet precursors, their alteration affects platelet morphology and function, which might have implications in hemostasis as demonstrated previously, so it is important to continue evaluating the effects of toxics and pollutants on megakaryocytes and platelets.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Teresa I Fortoul
- Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Rusak T, Misztal T, Piszcz J, Tomasiak M. Nitric oxide scavenging by cell-free hemoglobin may be a primary factor determining hypertension in polycythemic patients. Free Radic Res 2013; 48:230-8. [PMID: 24180690 DOI: 10.3109/10715762.2013.860225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We tested the hypothesis that hypertension associated with polycythemia vera (PV) may be related to hemoglobin released from erythrocytes (cell-free hemoglobin, fHb). We assessed hematocrit, mean arterial pressure (MAP), blood viscosity, and the level of fHb and nitrite/nitrate (NOx) in the plasma of 73 PV patients and 38 healthy controls. The effect of isovolemic erythrocytapheresis (ECP) on the considered parameters was also studied. From the whole group of PV patients a subset of subjects with normal (normotensive patients, n = 16) and elevated MAP (hypertensive patients, n = 57) can be subtracted. It was found that in comparison with healthy controls, PV patients have significantly (p ≤ 0.01) elevated Hct (0.567 vs. 0.422), blood viscosity (5.45 vs. 3.56 cP), MAP (106.8 vs. 93.8 mmHg), plasma fHb (9.7 vs. 2.8 mg/dL), and NOx levels (34.1 vs. 27.5 μM). Compared with normotensive patients, hypertensive PV patients demonstrated a higher rise in fHb (10.2 vs. 8.0) and plasma NOx levels (35.8 vs. 31.0). In PV patients, fHb positively correlates with MAP (r = 0.489), NOx levels (r = 0.461), hematocrit (r = 0.428), and viscosity (r = 0.393). Blood viscosity positively correlated with hematocrit (r = 0.894), but not with other considered parameters. In PV patients MAP poorly correlated with hematocrit, whereas the correlation between MAP and NOx altered from - 0.325 (healthy control) to + 0.268 (PV patients). ECP procedure was associated with a significant (p < 0.01) reduction of hematocrit, fHb, blood viscosity, and MAP. In the normotensive subgroup of PV patients the ECP procedure did not affect MAP. It can be concluded that accelerated scavenging of nitric oxide by fHb rather than high Hct may be a key factor determining the development of hypertension in PV patients.
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Affiliation(s)
- T Rusak
- Department of Physical Chemistry, Medical University of Bialystok , Bialystok , Poland
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Fantasia F, Di Capua EN, Cenfra N, Pessina G, Mecarocci S, Rago A, Cotroneo E, Busanello A, Equitani F, Lo-Coco F, Nervi C, Cimino G. A highly specific q-RT-PCR assay to address the relevance of the JAK2WT and JAK2V617F expression levels and control genes in Ph-negative myeloproliferative neoplasms. Ann Hematol 2013; 93:609-16. [PMID: 24173087 PMCID: PMC3945640 DOI: 10.1007/s00277-013-1920-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 11/25/2022]
Abstract
In Ph- myeloproliferative neoplasms, the quantification of the JAK2V617F transcripts may provide some advantages over the DNA allele burden determination. We developed a q-RT-PCR to assess the JAK2WT and JAK2V617F mRNA expression in 105 cases (23 donors, 13 secondary polycythemia, 22 polycythemia vera (PV), 38 essential thrombocythemia (ET), and 9 primary myelofibrosis (PMF)). Compared with the standard allele-specific oligonucleotide (ASO)-PCR technique, our assay showed a 100 % concordance rate detecting the JAK2V617F mutation in 22/22 PV (100 %), 29/38 (76.3 %) ET, and 5/9 (55.5 %) PMF cases, respectively. The sensitivity of the assay was 0.01 %. Comparing DNA and RNA samples, we found that the JAK2V617F mutational ratios were significantly higher at the RNA level both in PV (p = 0.005) and ET (p = 0.001) samples. In PV patients, JAK2WT expression levels positively correlated with the platelets (PLTs) (p = 0.003) whereas a trend to negative correlation was observed with the Hb levels (p = 0.051). JAK2V617F-positive cases showed the lowest JAK2WT and ABL1 mRNA expression levels. In all the samples, the expression pattern of beta-glucoronidase (GUSB) was more homogeneous than that of ABL1 or β2 microglobulin (B2M). Using GUSB as normalizator gene, a significant increase of the JAK2V617F mRNA levels was seen in two ET patients at time of progression to PV. In conclusion, the proposed q-RT-PCR is a sensitive and accurate method to quantify the JAK2 mutational status that can also show clinical correlations suggesting the impact of the residual amount of the JAK2WT allele on the Ph- MPN disease phenotype. Our observations also preclude the use of ABL1 as a housekeeping gene for these neoplasms.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Janus Kinase 2/biosynthesis
- Janus Kinase 2/genetics
- K562 Cells
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/diagnosis
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/genetics
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/metabolism
- Male
- Middle Aged
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/metabolism
- Real-Time Polymerase Chain Reaction/standards
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Affiliation(s)
- Francesca Fantasia
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza” Polo Pontino, , Latina, Italy
| | - Emma Nora Di Capua
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza” Polo Pontino, , Latina, Italy
| | - Natalia Cenfra
- Department of Cellular Biotechnology and Hematology, University of Rome “Sapienza”–Polo Pontino, via Benevento 6, 00161 Rome, Italy
| | - Gloria Pessina
- Molecular Biology Laboratory, AUSL-VT, Belcolle Hospital, Viterbo, Italy
| | - Sergio Mecarocci
- Hematology unit (2U), S. Maria Goretti Hospital/ICOT, AUSL Latina, Latina, Italy
| | - Angela Rago
- Hematology unit (2U), S. Maria Goretti Hospital/ICOT, AUSL Latina, Latina, Italy
| | - Ettore Cotroneo
- Department of Biomedicine and Prevention, University “Tor Vergata”,, Rome, Italy
| | - Anna Busanello
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza” Polo Pontino, , Latina, Italy
| | - Francesco Equitani
- Transfusion Medicine and Immuno-Hematology Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University “Tor Vergata”,, Rome, Italy
- Laboratory of Neuro-Oncohematology, Santa Lucia Foundation, Rome, Italy
| | - Clara Nervi
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome “Sapienza” Polo Pontino, , Latina, Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Hematology, University of Rome “Sapienza”–Polo Pontino, via Benevento 6, 00161 Rome, Italy
- Hematology unit (2U), S. Maria Goretti Hospital/ICOT, AUSL Latina, Latina, Italy
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Cheminant M, Delarue R. Prise en charge diagnostique et thérapeutique d’un patient porteur d’une thrombocytose. Rev Med Interne 2013; 34:465-71. [DOI: 10.1016/j.revmed.2013.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
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Karahan SC, Sonmez M, Saglam F, Mentese A, Erkut N, Topbas M, Kopuz M, Cobanoglu U. Can ischemia-modified albumin be a valuable indicator of tissue ischemia in polycythemia vera? Hematology 2013; 15:151-6. [DOI: 10.1179/102453309x12583347113410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- S. Caner Karahan
- Department of BiochemistrySchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Mehmet Sonmez
- Department of HematologySchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Fatma Saglam
- Department of Internal MedicineSchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Mentese
- Department of BiochemistrySchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nergiz Erkut
- Department of HematologySchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Murat Topbas
- Department of Public HealthSchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Muge Kopuz
- Department of BiochemistrySchool of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Umit Cobanoglu
- Department of Pathology School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Osca-Gelis G, Puig-Vives M, Saez M, Gallardo D, Lloveras N, Marcos-Gragera R. Population-based incidence of myeloid malignancies: fifteen years of epidemiological data in the province of Girona, Spain. Haematologica 2013; 98:e95-7. [PMID: 23812933 DOI: 10.3324/haematol.2013.084061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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31
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Lin HC, Chen CGS, Chang MC, Wang WT, Kao CW, Lo AC, Su NW, Chang YC, Chiang YH, Chou KF, Liao PN, Cai GJ, Cheng HI, Lin J, Chang YF, Hsieh RK, Lim KH. JAK2 V617F Mutation in Adult Taiwanese Patients with Essential Thrombocythemia: More Prevalent in Old Patients and Correlated with Higher Hemoglobin Level and Higher Leukocyte Count. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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32
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Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, De Stefano V, Elli E, Iurlo A, Latagliata R, Lunghi F, Lunghi M, Marfisi RM, Musto P, Masciulli A, Musolino C, Cascavilla N, Quarta G, Randi ML, Rapezzi D, Ruggeri M, Rumi E, Scortechini AR, Santini S, Scarano M, Siragusa S, Spadea A, Tieghi A, Angelucci E, Visani G, Vannucchi AM, Barbui T. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med 2013; 368:22-33. [PMID: 23216616 DOI: 10.1056/nejmoa1208500] [Citation(s) in RCA: 519] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Current treatment recommendations for patients with polycythemia vera call for maintaining a hematocrit of less than 45%, but this therapeutic strategy has not been tested in a randomized clinical trial. METHODS We randomly assigned 365 adults with JAK2-positive polycythemia vera who were being treated with phlebotomy, hydroxyurea, or both to receive either more intensive treatment (target hematocrit, <45%) (low-hematocrit group) or less intensive treatment (target hematocrit, 45 to 50%) (high-hematocrit group). The primary composite end point was the time until death from cardiovascular causes or major thrombotic events. The secondary end points were cardiovascular events, cardiovascular hospitalizations, incidence of cancer, progression to myelofibrosis, myelodysplasia or leukemic transformation, and hemorrhage. An intention-to-treat analysis was performed. RESULTS After a median follow-up of 31 months, the primary end point was recorded in 5 of 182 patients in the low-hematocrit group (2.7%) and 18 of 183 patients in the high-hematocrit group (9.8%) (hazard ratio in the high-hematocrit group, 3.91; 95% confidence interval [CI], 1.45 to 10.53; P=0.007). The primary end point plus superficial-vein thrombosis occurred in 4.4% of patients in the low-hematocrit group, as compared with 10.9% in the high-hematocrit group (hazard ratio, 2.69; 95% CI, 1.19 to 6.12; P=0.02). Progression to myelofibrosis, myelodysplasia or leukemic transformation, and bleeding were observed in 6, 2, and 2 patients, respectively, in the low-hematocrit group, as compared with 2, 1, and 5 patients, respectively, in the high-hematocrit group. There was no significant between-group difference in the rate of adverse events. CONCLUSIONS In patients with polycythemia vera, those with a hematocrit target of less than 45% had a significantly lower rate of cardiovascular death and major thrombosis than did those with a hematocrit target of 45 to 50%. (Funded by the Italian Medicines Agency and others; ClinicalTrials.gov number, NCT01645124, and EudraCT number, 2007-006694-91.).
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Jadli A, Kulkarni B, Ghosh K, Shetty S. Non conventional mutations associated with myeloproliferative disorders are absent in splanchnic venous thrombosis cases. Liver Int 2012; 32:1596-7. [PMID: 22816981 DOI: 10.1111/j.1478-3231.2012.02851.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Anshul Jadli
- National Institute of Immunohaematology (ICMR); Mumbai; India
| | - Bipin Kulkarni
- National Institute of Immunohaematology (ICMR); Mumbai; India
| | - Kanjaksha Ghosh
- National Institute of Immunohaematology (ICMR); Mumbai; India
| | - Shrimati Shetty
- National Institute of Immunohaematology (ICMR); Mumbai; India
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34
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Barcelos MM, Santos-Silva MC. Molecular approach to diagnose BCR/ABL negative chronic myeloproliferative neoplasms. Rev Bras Hematol Hemoter 2012; 33:290-6. [PMID: 23049320 PMCID: PMC3415756 DOI: 10.5581/1516-8484.20110079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 04/01/2011] [Indexed: 01/01/2023] Open
Abstract
Chronic myeloproliferative neoplasms arise from clonal proliferation of hematopoietic stem cells. According to the World Health Organization myeloproliferative neoplasms are classified as: chronic myelogenous leukemia, polycythemia vera, essential thrombocythemia, primary myelofibrosis, chronic neutrophilic leukemia, chronic eosinophilic leukemia, hypereosinophilic syndrome, mast cell disease, and unclassifiable myeloproliferative neoplasms. In the revised 2008 WHO diagnostic criteria for myeloproliferative neoplasms, mutation screening for JAK2V617F is considered a major criterion for polycythemia vera diagnosis and also for essential thrombocythemia and primary myelofibrosis, the presence of this mutation represents a clonal marker. There are currently two hypotheses explaining the role of the JAK2V617F mutation in chronic myeloproliferative neoplasms. According to these theories, the mutation plays either a primary or secondary role in disease development. The discovery of the JAK2V617F mutation has been essential in understanding the genetic basis of chronic myeloproliferative neoplasms, providing some idea on how a single mutation can result in three different chronic myeloproliferative neoplasm phenotypes. But there are still some issues to be clarified. Thus, studies are still needed to determine specific molecular markers for each subtype of chronic myeloproliferative neoplasm.
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35
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Choe WH, Park BG, Lee KH, Lee JH, Lee JH, Kwon SW. Automated double red-cell phlebotomy for the treatment of erythrocytosis. J Clin Apher 2012; 27:255-9. [DOI: 10.1002/jca.21241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/14/2012] [Indexed: 01/19/2023]
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36
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Singla A, Jagasia D, Garg M, Lowry PA, Stapleton D. Acute ST-segment elevation myocardial infarction: A rare initial presentation of previously undiagnosed essential thrombocythemia. Platelets 2012; 23:463-6. [DOI: 10.3109/09537104.2011.640966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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37
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Structure-based design of oxygen-linked macrocyclic kinase inhibitors: discovery of SB1518 and SB1578, potent inhibitors of Janus kinase 2 (JAK2) and Fms-like tyrosine kinase-3 (FLT3). J Comput Aided Mol Des 2012; 26:437-50. [DOI: 10.1007/s10822-012-9572-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/11/2012] [Indexed: 01/31/2023]
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38
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Kato T, Kawana S. An ulceronecrotic foot lesion in a patient with essential thrombocythemia: successful treatment with hydroxyurea. Case Rep Dermatol 2012; 4:10-3. [PMID: 22308114 PMCID: PMC3271840 DOI: 10.1159/000335997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The patient was a 47-year-old woman with a painful ulcer that had appeared on the right 5th toe two weeks before she visited our hospital. Histopathological examination showed that thrombi were present in small blood vessels in the dermis and pancytosis was detected in a blood test, suggesting polycythemia-associated ulceration of the toe. Essential thrombocythemia was diagnosed based on bone marrow puncture and chromosomal test findings. Platelet count and the ulcer were improved by oral hydroxyurea.
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Affiliation(s)
- Tokue Kato
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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39
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Twice daily aspirin to improve biological aspirin efficacy in patients with essential thrombocytemia. Thromb Res 2012; 129:91-4. [DOI: 10.1016/j.thromres.2011.09.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/08/2011] [Accepted: 09/16/2011] [Indexed: 11/23/2022]
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40
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Abstract
Special issues in myeloproliferative neoplasms (MPN) comprise clinical conditions with high relevance for the duration and quality of the patient's life, but with limited evidence to support sound diagnostic and therapeutic recommendations and a low probability of being solved by the current standard of clinical research. These issues include MPN in pregnancy and in children, abdominal vein thrombosis, bleeding complications, surgery, pruritus, and leukemic transformation. Practical suggestions to guide clinical decisions in these settings remain largely empirical, but recently developed guidelines based on experts' consensus may help to tackle these problems. This article reviews the state of the art regarding these issues, with special emphasis on experts' consensus recommendations.
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41
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Assessment and prognostic value of the European LeukemiaNet criteria for clinicohematologic response, resistance, and intolerance to hydroxyurea in polycythemia vera. Blood 2011; 119:1363-9. [PMID: 22160617 DOI: 10.1182/blood-2011-10-387787] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Criteria of response and definition of resistance and intolerance to hydroxyurea (HU) in polycythemia vera (PV) were proposed by the European LeukemiaNet (ELN). Such criteria were evaluated in 261 PV patients (median follow-up, 7.2 years) treated with HU for a median of 4.4 years. Complete response, partial response, and no response were observed in 24%, 66%, and 10% of patients, respectively. Achieving ELN response (complete or partial) or hematocrit response did not result in better survival or less thrombosis and bleeding. On the contrary, having no response in leukocyte count was associated with higher risk of death (HR, 2.7; 95% confidence interval [CI], 1.3%-5.4%; P = .007), whereas lack of response in platelet count involved a higher risk of thrombosis and bleeding. Resistance and intolerance to HU was registered in 11% and 13% of patients, respectively. Resistance to HU was associated with higher risk of death (HR, 5.6; 95% CI, 2.7%-11.9%; P < .001) and transformation (HR, 6.8; 95% CI, 3.0%-15.4%; P < .001). In summary, fulfilling the ELN definition for response to HU was not associated with a benefit in the clinical outcome in PV, whereas response in platelet and white blood cell counts were predictive of less thrombohemorrhagic complications and better prognosis, respectively. Resistance to HU was an adverse prognostic factor.
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Rusak T, Ciborowski M, Uchimiak-Owieczko A, Piszcz J, Radziwon P, Tomasiak M. Evaluation of hemostatic balance in blood from patients with polycythemia vera by means of thromboelastography: The effect of isovolemic erythrocytapheresis. Platelets 2011; 23:455-62. [DOI: 10.3109/09537104.2011.633178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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González-Villalva A, Piñón-Zárate G, De la Peña Díaz A, Flores-García M, Bizarro-Nevares P, Rendón-Huerta EP, Colín-Barenque L, Fortoul TI. The effect of vanadium on platelet function. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2011; 32:447-456. [PMID: 22004965 DOI: 10.1016/j.etap.2011.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 08/04/2011] [Accepted: 08/23/2011] [Indexed: 05/31/2023]
Abstract
Vanadium pentoxide (V(2)O(5)) inhalation effect on platelet function in mice was explored, as well as the in vitro effect on human platelets. Mouse blood samples were collected and processed for aggregometry and flow cytometry to assess the presence of P-selectin and monocyte-platelet conjugates. Simultaneously, human platelets were processed for aggregometry(.) The mouse results showed platelet aggregation inhibition in platelet-rich-plasma (PRP) at four-week exposure time, and normality returned at eight weeks of exposure, remaining unchanged after the exposure was discontinued after four weeks. This platelet aggregation inhibition effect was reinforced with the in vitro assay. In addition, P-selectin preserved their values during the exposure, until the exposure was discontinued during four weeks, when this activation marker increased. We conclude that vanadium affects platelet function, but further studies are required to evaluate its effect on other components of the hemostatic system.
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Affiliation(s)
- Adriana González-Villalva
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, CP 04510, Mexico City, Mexico.
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Thakur KT, Westover MB. Cerebral infarction due to smoker's polycythemia. BMJ Case Rep 2011; 2011:bcr.08.2011.4714. [PMID: 22675101 DOI: 10.1136/bcr.08.2011.4714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
A 65-year-old man presented with fluctuating focal neurological deficits and neuroimaging findings of multiple small cerebral infarctions. His medical investigation revealed a >100 pack/year smoking history, and a haematocrit >60. Subsequent investigations led to a diagnosis of cerebral infarction due to smoker's polycythemia, the third such case reported in the medical literature. The patient's neurological deficits resolved completely with subsequent haematocrit reduction. This brief report reviews the differential diagnosis of polycythemia, current knowledge of the mechanisms by which smoker's polycythemia may lead to ischemic stroke, and recommendations for management.
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Affiliation(s)
- Kiran Teresa Thakur
- Massachusetts General Hospital, Department of Neurology, Boston, Massachusetts, United States
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45
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Linnemann B, Kraft C, Roskos M, Zgouras D, Lindhoff-Last E. Inferior vena cava thrombosis and its relationship with the JAK2V617F mutation and chronic myeloproliferative disease. Thromb Res 2011; 129:720-4. [PMID: 21982959 DOI: 10.1016/j.thromres.2011.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/09/2011] [Accepted: 09/14/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Splanchnic vein thrombosis (SVT) is a typical manifestation of polycythaemia vera (PV) or essential thrombocythaemia (ET). The recently discovered JAK2V617F somatic mutation is closely associated with chronic myeloproliferative disease (CMD). We investigated whether thrombosis involving the inferior vena cava (IVC) is also related to the JAK2V617F mutation or CMD. METHODS Blood samples were obtained from 40 IVC thrombosis patients. Fifty-three patients with isolated lower extremity deep vein thrombosis (LE-DVT) and 20 SVT patients served as controls. The presence of the JAK2V617F mutation was assessed by real-time polymerase chain reaction (RT-PCR). RESULTS The JAK2V617F allele was not detected in any of the IVC thrombosis patients but was detected in one patient (2%) with isolated LE-DVT. However, the mutation-carrying patient did not exhibit symptoms of CMD. Even after an observation period of 30months, the patient's complete blood cell count did not exhibit any pathology. In contrast, the JAK2V617F allele was detected in four patients with SVT (20%) and CMD. CONCLUSION According to our data, there is no evidence that IVC thrombosis is associated with the JAK2V617F mutation or the presence of chronic myeloproliferative disease.
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Affiliation(s)
- Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, J.W. Goethe University Hospital Frankfurt/Main, Germany.
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46
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Sandberg AA, Meloni-Ehrig AM. Cytogenetics and genetics of human cancer: methods and accomplishments. ACTA ACUST UNITED AC 2010; 203:102-26. [DOI: 10.1016/j.cancergencyto.2010.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 09/22/2010] [Accepted: 10/07/2010] [Indexed: 12/31/2022]
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47
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Hoeller S, Walz C, Reiter A, Dirnhofer S, Tzankov A. PCM1–JAK2-fusion: a potential treatment target in myelodysplastic–myeloproliferative and other hemato-lymphoid neoplasms. Expert Opin Ther Targets 2010; 15:53-62. [DOI: 10.1517/14728222.2011.538683] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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48
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Portal, splenic and mesenteric vein thrombosis in a patient double heterozygous for factor V Leiden and prothrombin G20210A mutation. Blood Coagul Fibrinolysis 2010; 20:722-5. [PMID: 19734780 DOI: 10.1097/mbc.0b013e3283306e3c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We herein report a 56-year-old man who presented with abdominal pain, diarrhea and a 22-kg-weight loss over 4 months. He was on acenocoumarol treatment because of portal, splenic and mesenteric vein thrombosis (PSMVT) 3 months before, with admission international normalized ratio (INR):1.6. Doppler ultrasonography and helical computerized tomographic scan of the abdomen showed complete thrombosis of the extrahepatic portal vein extending into the superior mesenteric vein and splenic vein. The manifestation of thrombosis was in the absence of provocative stimuli or local cause. The patient had a negative history of venous thromboembolism. Thrombophilia workup revealed double heterozygosity for factor V Leiden and prothrombin G20210A mutation. He was immediately started with intravenous unfractionated heparin, followed by oral anticoagulation with target INR 2-3. Five days after a Doppler examination showed significant improvement in the flow within the portal vein, and a computerized tomographic scan of the abdomen 1 month later showed extensive recanalization of the portal venous system. The patient is now 36 months out from the second PSMVT episode and is doing well although maintaining oral lifelong anticoagulation. The case is of particular interest in that PSMVT was the first manifestation of this combined disorder. We conclude that all patients presenting with unexplained PSMVT should be investigated for the presence of a hypercoagulable state. Anticoagulation should be considered in all patients with this diagnosis and should be a lifelong therapy in those with an underlying thrombophilia.
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Abstract
Myeloproliferative disorders and the serum hyperviscosity syndrome can rapidly manifest with emergent presentations. Hyperviscosity occurs from pathologic elevations of either the cellular or acellular (protein) fractions of the circulating blood. Classic hyperviscosity syndrome presents with the triad of bleeding diathesis, visual disturbances, and focal neurologic signs. Emergency medicine providers should be aware of these conditions and be prepared to rapidly initiate supportive and early definitive management, including plasma exchange and apharesis. Early consultation with a hematologist is essential to managing these complex patients.
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