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Frank C, Amily N, Kelly E, Kimpton M, Villeneuve P, O'Meara P. Polycythemia vera and noncirrhotic portal hypertension diagnosed during pregnancy. CMAJ 2024; 196:E657-E660. [PMID: 38772602 PMCID: PMC11104577 DOI: 10.1503/cmaj.231170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024] Open
Affiliation(s)
- Cairina Frank
- Departments of Medicine (Frank, Kelly, Kimpton, Villeneuve, O'Meara) and Obstetrics and Gynecology (Amily), University of Ottawa, Ottawa, Ont.
| | - Noor Amily
- Departments of Medicine (Frank, Kelly, Kimpton, Villeneuve, O'Meara) and Obstetrics and Gynecology (Amily), University of Ottawa, Ottawa, Ont
| | - Erin Kelly
- Departments of Medicine (Frank, Kelly, Kimpton, Villeneuve, O'Meara) and Obstetrics and Gynecology (Amily), University of Ottawa, Ottawa, Ont
| | - Miriam Kimpton
- Departments of Medicine (Frank, Kelly, Kimpton, Villeneuve, O'Meara) and Obstetrics and Gynecology (Amily), University of Ottawa, Ottawa, Ont
| | - Pierre Villeneuve
- Departments of Medicine (Frank, Kelly, Kimpton, Villeneuve, O'Meara) and Obstetrics and Gynecology (Amily), University of Ottawa, Ottawa, Ont
| | - Paloma O'Meara
- Departments of Medicine (Frank, Kelly, Kimpton, Villeneuve, O'Meara) and Obstetrics and Gynecology (Amily), University of Ottawa, Ottawa, Ont
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2
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Nguyen T, Park S, Park J, Sodager A, George T, Gandjbakhche A. Application of the Single Source-Detector Separation Algorithm in Wearable Neuroimaging Devices: A Step toward Miniaturized Biosensor for Hypoxia Detection. Bioengineering (Basel) 2024; 11:385. [PMID: 38671806 PMCID: PMC11048477 DOI: 10.3390/bioengineering11040385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Most currently available wearable devices to noninvasively detect hypoxia use the spatially resolved spectroscopy (SRS) method to calculate cerebral tissue oxygen saturation (StO2). This study applies the single source-detector separation (SSDS) algorithm to calculate StO2. Near-infrared spectroscopy (NIRS) data were collected from 26 healthy adult volunteers during a breath-holding task using a wearable NIRS device, which included two source-detector separations (SDSs). These data were used to derive oxyhemoglobin (HbO) change and StO2. In the group analysis, both HbO change and StO2 exhibited significant change during a breath-holding task. Specifically, they initially decreased to minimums at around 10 s and then steadily increased to maximums, which were significantly greater than baseline levels, at 25-30 s (p-HbO < 0.001 and p-StO2 < 0.05). However, at an individual level, the SRS method failed to detect changes in cerebral StO2 in response to a short breath-holding task. Furthermore, the SSDS algorithm is more robust than the SRS method in quantifying change in cerebral StO2 in response to a breath-holding task. In conclusion, these findings have demonstrated the potential use of the SSDS algorithm in developing a miniaturized wearable biosensor to monitor cerebral StO2 and detect cerebral hypoxia.
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Affiliation(s)
| | | | | | | | | | - Amir Gandjbakhche
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892-4480, USA; (T.N.); (S.P.); (J.P.); (A.S.); (T.G.)
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Aoun M, Jadoul M, Anders HJ. Erythrocytosis and CKD: A Review. Am J Kidney Dis 2024:S0272-6386(24)00715-7. [PMID: 38621632 DOI: 10.1053/j.ajkd.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 04/17/2024]
Abstract
Erythrocytosis or polycythemia is defined as an increase in red blood cell concentration above the age- and sex-specific normal levels. Unlike anemia, which is very common in patients with chronic kidney disease (CKD), erythrocytosis is less frequent but requires specific understanding by health care professionals in order to provide the best care. Erythrocytosis, especially when undiagnosed and untreated, can lead to serious thrombotic events and higher mortality. Classic causes of erythrocytosis associated with CKD include cystic kidney diseases, kidney or other erythropoietin-secreting neoplasms, high-altitude renal syndrome, overdosage of erythropoietin-stimulating agents, androgen therapy, heavy smoking, chronic lung disease, obstructive sleep apnea, IgA nephropathy, post-kidney transplant erythrocytosis, renal artery stenosis, and congenital etiologies. After ruling out the common acquired causes of erythrocytosis and/or in the presence of suggestive parameters, primary erythrocytosis or polycythemia vera (PV) should be considered, and patients should be screened for JAK2V617F somatic mutation. The newest entity inducing erythrocytosis is linked to the use of sodium/glucose cotransporter 2 (SGLT2) inhibitors that hypothetically activate hypoxia-inducible factor 2α (HIF-2α) and in some cases unmask PV. This Review focuses on the pathogenesis, renal manifestations and management of PV, the pathophysiology of erythrocytosis induced by SGLT2 inhibitors and the relevance of timely JAK2 mutation screening in these patients.
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Affiliation(s)
- Mabel Aoun
- Fondation AUB Santé, Lorient, France; Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon.
| | - Michel Jadoul
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilians University, Munich, Germany
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4
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Almanaseer A, Chin-Yee B, Ho J, Lazo-Langner A, Schenkel L, Bhai P, Sadikovic B, Chin-Yee IH, Hsia CC. An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis. Adv Hematol 2024; 2024:3056216. [PMID: 38375212 PMCID: PMC10876298 DOI: 10.1155/2024/3056216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
Background Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. Methods and Results All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p < 0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p < 0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p < 0.01). Conclusion A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing.
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Affiliation(s)
- Ala Almanaseer
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Ho
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Laila Schenkel
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Ian H. Chin-Yee
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
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5
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Tang P, Wang H. Regulation of erythropoiesis: emerging concepts and therapeutic implications. Hematology 2023; 28:2250645. [PMID: 37639548 DOI: 10.1080/16078454.2023.2250645] [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] [Received: 04/19/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
The process of erythropoiesis is complex and involves the transfer of cells from the yolk sac to the fetal hepar and, ultimately, to the bone marrow during embryonic development. Within the bone marrow, erythroid progenitor cells undergo several stages to generate reticulocytes that enter the bloodstream. Erythropoiesis is regulated by various factors, with erythropoietin (EPO) synthesized by the kidney being the promoting factor and hepcidin synthesized by the hepar inhibiting iron mobilization. Transcription factors, such as GATA and KLF, also play a crucial role in erythropoiesis. Disruption of any of these factors can lead to abnormal erythropoiesis, resulting in red cell excess, red cell deficiency, or abnormal morphological function. This review provides a general description of erythropoiesis, as well as its regulation, highlighting the significance of understanding the process for the diagnosis and treatment of various hematological disorders.
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Affiliation(s)
- Pu Tang
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Huaquan Wang
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
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Jaiswal R, Johansson H, Axelsson KF, Magnusson P, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Johansson L, Lorentzon M. Hemoglobin Levels Improve Fracture Risk Prediction in Addition to FRAX Clinical Risk Factors and Bone Mineral Density. J Clin Endocrinol Metab 2023; 108:e1479-e1488. [PMID: 37406247 PMCID: PMC10655535 DOI: 10.1210/clinem/dgad399] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
CONTEXT Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown. OBJECTIVE To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs). METHODS A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive. RESULTS The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively. CONCLUSION Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.
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Affiliation(s)
- Raju Jaiswal
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Helena Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Kristian F Axelsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Norrmalm, Health Centre, 549 40 Skövde, Sweden
| | - Per Magnusson
- Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liesbeth Vandenput
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mattias Lorentzon
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
- Region Västra Götaland, Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
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Zheng Y, He Y, Kang N, Zhang C, Liao W, Yuchi Y, Liu X, Hou J, Mao Z, Huo W, Zhang K, Tian H, Lin H, Wang C. Associations of Long-Term Exposure to PM 2.5 and Its Constituents with Erythrocytosis and Thrombocytosis in Rural Populations. TOXICS 2023; 11:885. [PMID: 37999537 PMCID: PMC10674504 DOI: 10.3390/toxics11110885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023]
Abstract
Evidence on the effect of long-term exposure to fine particulate matter (PM2.5) on erythrocytosis and thrombocytosis prevalence was limited. We aimed to investigate the association of PM2.5 and its constituents with the risks of erythrocytosis and thrombocytosis. The present study included a total of 33,585 participants from the Henan Rural Cohort at baseline between 2015 and 2017. A hybrid satellite-based model was employed to estimate the concentrations of PM2.5 mass and its constituents (including black carbon [BC], nitrate [NO3-], ammonium [NH4+], inorganic sulfate [SO42-], organic matter [OM], and soil particles [SOIL]). The logistic regression model was used to assess the associations of single exposure to PM2.5 and its constituents with the risks of erythrocytosis and thrombocytosis, and the quantile G-computation method was applied to evaluate their joint exposure risk. For the independent association, the odds ratios for erythrocytosis/thrombocytosis with 1 μg/m3 increase was 1.049/1.043 for PM2.5 mass, 1.596/1.610 for BC, 1.410/1.231 for NH4+, 1.205/1.139 for NO3-, 1.221/1.359 for OM, 1.300/1.143 for SO42-, and 1.197/1.313 for SOIL. Joint exposure to PM2.5 and its components was also positively associated with erythrocytosis and thrombocytosis. The estimated weight of NH4+ was found to be the largest for erythrocytosis, while OM had the largest weight for thrombocytosis. PM2.5 mass and its constituents were positively linked to prevalent erythrocytosis and thrombocytosis, both in single-exposure and joint-exposure models. Additionally, NH4+/OM was identified as a potentially responsible component for the association between PM2.5 and erythrocytosis/thrombocytosis.
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Affiliation(s)
- Yiquan Zheng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Yaling He
- Department of Occupational and Environmental Health, Ministry of Education, Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ning Kang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Caiyun Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Wei Liao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Yinghao Yuchi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY 12222, USA
| | - Hezhong Tian
- State Key Joint Laboratory of Environmental Simulation & Pollution Control, School of Environment, Beijing Normal University, Beijing 100875, China
| | - Hualiang Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510275, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
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Corona G, Sparano C, Rastrelli G, Vignozzi L, Maggi M. Developments and challenges for new and emergent preparations for male hypogonadism treatment. Expert Opin Investig Drugs 2023; 32:1071-1084. [PMID: 37943011 DOI: 10.1080/13543784.2023.2276760] [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] [Received: 04/03/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The specific role of testosterone (T) replacement therapy in patients with late onset hypogonadism is still conflicting. Several available preparations have been developed to restore either fertility and normal testosterone (T) levels (secondary hypogonadism) or just T levels (primary hypogonadism). AREAS COVERED Advantages and limitations related to available new treatments will be discussed in detail. In addition, possible news related to preparations in the pipeline will be discussed. EXPERT OPINION The selection of a specific T preparation should be adequately discussed with each subject. Transdermal T preparations are those that can preserve, after a unique morning administration, the circadian rhythmicity of T secretion. Conversely, short-acting preparations (such as oral or intranasal) need two- or three-times daily administration, potentially reducing patient compliance. Long acting T preparations, such as injectable T undecanoate have the advantage of bimestrial or trimestral administration, reducing the required number of administrations. The use of non-steroidal selective androgen receptor modulators (SARM), a heterogeneous class of compounds selectively acting on androgen receptor targets, remains investigational due to the lack of the full spectrum of T's action and the possible risk of side effects, despite their potential use in the treatment of muscle wasting and osteoporosis.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore Hospital, Azienda AUSL Bologna, Bolognas, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Female Endocrinology and Gender Incongruence Unit Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Chin-Yee B, Bhai P, Cheong I, Matyashin M, Hsia CC, Kawata E, Ho JM, Levy MA, Stuart A, Lin H, Chin-Yee I, Kadour M, Sadikovic B, Lazo-Langner A. A Rational Approach to JAK2 Mutation Testing in Patients with Elevated Hemoglobin: Results from the JAK2 Prediction Cohort (JAKPOT) Study. J Gen Intern Med 2023; 38:1828-1833. [PMID: 36451015 PMCID: PMC10271984 DOI: 10.1007/s11606-022-07963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Erythrocytosis, most often measured as an increase in hemoglobin and/or hematocrit, is a common reason for referral to internal medicine and hematology clinics and a rational approach is required to effectively identify patients with polycythemia vera while avoiding over-investigation. AIM We aimed to develop and validate a simple rule to predict JAK2 mutation positivity based on complete blood count parameters to aid in the diagnostic approach to patients referred for elevated hemoglobin. SETTING Internal medicine and hematology clinics at an academic tertiary referral center. PARTICIPANTS The JAK2 Prediction Cohort (JAKPOT), a large retrospective cohort (n = 901) of patients evaluated by internal medicine and hematology specialists for elevated hemoglobin. DESIGN JAK2 mutation analysis was performed in all patients and clinical and laboratory variables were collected. Patients were randomly divided into derivation and validation cohorts. A prediction rule was developed using data from the derivation cohort and tested in the validation cohort. KEY RESULTS The JAKPOT prediction rule included three variables: (i) red blood cell count >6.45×1012/L, (ii) platelets >350×109/L, and (iii) neutrophils >6.2×109/L; absence of all criteria was effective at ruling out JAK2-positivity with sensitivities 94.7% and 100%, and negative predictive values of 98.8% and 100% in the derivation and validation cohorts, respectively, with an overall low false negative rate of 0.4%. The rule was validated for three different methods of JAK2 testing. Applying this rule to our entire cohort would have resulted in over 50% fewer tests. CONCLUSION In patients with elevated hemoglobin, the use of a simple prediction rule helps to accurately identify patients with a low likelihood of having a JAK2 mutation, potentially limiting costly over-investigation in this common referral population.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Ian Cheong
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Maxim Matyashin
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Cyrus C Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Eri Kawata
- Division of Hematology, Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Jenny M Ho
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael A Levy
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Stuart
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
| | - Hanxin Lin
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mike Kadour
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bekim Sadikovic
- Molecular Diagnostic Division, London Health Sciences Centre, London, Ontario, Canada
- Verspeeten Clinical Genome Centre, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alejandro Lazo-Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
- Division of Hematology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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10
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Babakhanlou R, Verstovsek S, Pemmaraju N, Rojas-Hernandez CM. Secondary erythrocytosis. Expert Rev Hematol 2023; 16:245-251. [PMID: 36927204 DOI: 10.1080/17474086.2023.2192475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Erythrocytosis is associated with an elevation of the hemoglobin level above 16.5 g/dL in men and above 16 g/dL in women and an elevation of the hematocrit level above 49% in men and > 48% in women. In primary erythrocytosis, the defect is a clonal disorder in the myeloid compartment of the bone marrow, leading to an increased red cell production. Secondary erythrocytosis is the result of external stimuli to the bone marrow, leading to the production of red cells in excess. Secondary erythrocytosis is more common than primary erythrocytosis and has a broad differential diagnosis. AREAS COVERED This review will discuss secondary erythrocytosis, its causes, clinical presentation, and both diagnostic and therapeutic approaches. EXPERT OPINION Although secondary erythrocytosis is more common than PV, there are still challenges and difficulties associated with the distinction between these two conditions. Moreover, there is a paucity of data and guidance when it comes to the management of certain congenital and acquired conditions. A pragmatic approach is recommended in order to identify the cause for this condition. Treatment should be directed at the management of the underlying cause.
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Affiliation(s)
- Rodrick Babakhanlou
- Department of Leukemia, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Srdan Verstovsek
- Department of Leukemia, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Pemmaraju
- Department of Leukemia, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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11
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Schattner A. Erythrocytosis as the Presenting Manifestation of Recurrent Metastatic Colorectal Cancer. Am J Med 2023; 136:e41-e42. [PMID: 36356918 DOI: 10.1016/j.amjmed.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ami Schattner
- Meuhedet HMO, Rehovot, Israel; The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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12
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Martelli V, Carelli E, Tomlinson GA, Orchanian-Cheff A, Kuo KHM, Lyons OD, Ryan CM. Prevalence of elevated hemoglobin and hematocrit levels in patients with obstructive sleep apnea and the impact of treatment with continuous positive airway pressure: a meta-analysis. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:889-901. [PMID: 35962574 DOI: 10.1080/16078454.2022.2109346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is reported to be a cause of secondary polycythemia. The present study (i) reviewed the literature reporting the prevalence of secondary polycythemia in patients with OSA and (ii) determined the effect of continuous positive airway pressure (CPAP) therapy on hemoglobin and hematocrit levels in patients with OSA. METHODS We searched MEDLINE, Embase and Cochrane for studies of adult patients with OSA that reported hemoglobin and/or hematocrit levels. We performed summary estimates of (i) polycythemia prevalence and a subgroup analysis according to OSA severity, and (ii) change in hemoglobin and hematocrit levels following treatment with CPAP. RESULTS Synthesis of seven studies including 3,654 patients revealed an overall polycythemia prevalence of 2% (95% CI 1-4%); 2% (95% CI 1-3%) in mild-to moderate and 6 % (95% CI 3-12%) in severe OSA. In the pooled analysis of ten single-arm trials including 434 patients, CPAP treatment reduced hemoglobin by 3.76 g/L (95% CI -4.73 to -2.80 g/L). Similarly, pooled analysis of ten single-arm trials including 356 patients without baseline polycythemia showed that CPAP treatment reduced hematocrit by 1.1% (95% CI -1.4 to -0.9%). CONCLUSION Our pooled analysis supports an increased prevalence of secondary polycythemia in OSA. This estimated prevalence is likely underestimated due to the change in the polycythemia diagnostic criteria in 2016. Future randomized controlled trials are needed to evaluate the effect of CPAP in patients with baseline polycythemia. HIGHLIGHTS Pooled analysis shows OSA is associated with an increased prevalence of secondary polycythemiaPrevalence of polycythemia is greater in severe OSACPAP treatment for OSA reduces both the hemoglobin and hematocrit.
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Affiliation(s)
| | - Eric Carelli
- Department of Medicine, University of Toronto, Toronto, Canada
| | - George A Tomlinson
- Toronto General Hospital Research Institute, Toronto, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Canada
| | - Kevin H M Kuo
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Medical Oncology & Hematology, University Health Network, Toronto, Canada
| | - Owen D Lyons
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Respirology, Women's College Hospital, Toronto, Canada.,Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Canada.,Division of Respirology, University Health Network, Toronto, Canada
| | - Clodagh M Ryan
- Toronto General Hospital Research Institute, Toronto, Canada.,Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Canada.,Division of Respirology, University Health Network, Toronto, Canada
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13
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Langabeer SE. Absence of JAK2 V617F-mutated polycythemia vera in obstructive sleep apnea-associated erythrocytosis. Sleep Med X 2022; 4:100058. [PMID: 36299528 PMCID: PMC9589194 DOI: 10.1016/j.sleepx.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Stephen E. Langabeer
- Corrresponding author. Cancer Molecular Diagnostics, St. James's Hospital, Dublin, D08 W9RT, Ireland.
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14
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Chin-Yee B, Matyashin M, Cheong I, Bhai P, Lazo-Langner A, Almanaseer A, Kawata E, Levy MA, Stuart A, Lin H, Chin-Yee I, Sadikovic B, Hsia C. Secondary causes of elevated hemoglobin in patients undergoing molecular testing for suspected polycythemia vera in southwestern Ontario: a chart review. CMAJ Open 2022; 10:E988-E992. [PMID: 36347562 PMCID: PMC9648622 DOI: 10.9778/cmajo.20210322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Molecular testing for JAK2 mutations is part of the standard diagnostic workup for patients with suspected polycythemia vera. We sought to characterize evolving practice patterns in the investigation of erythrocytosis and the prevalence of secondary causes, including use of medications such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, among patients who underwent molecular testing. METHODS We reviewed charts of all consecutive patients investigated for erythrocytosis (hemoglobin > 160 g/L for women, > 165 g/L for men) with JAK2 testing between 2015 and 2021 at London Health Sciences Centre, a tertiary referral centre in Ontario, Canada, to assess changes in rates of JAK2 mutation positivity, average hemoglobin levels and the prevalence of secondary causes of erythrocytosis. RESULTS A total of 891 patients with erythrocytosis underwent JAK2 mutation testing with an increase in number of tests (particularly from 2017 to 2018), a decrease in the rate of JAK2 positivity and similar average hemoglobin levels over the study period. We observed a high proportion of patients with secondary causes of erythrocytosis, ranging from 59% to 74% over the study period, including medications associated with erythrocytosis, namely testosterone (6%-11%) and SGLT2 inhibitors (2%-19%). Stopping SGLT2 inhibitors was associated with a significant decrease in hemoglobin levels (mean -14.7 g/L, 95% confidence interval -18.9 to -10.5 g/L) compared with continuation. INTERPRETATION Use of SGLT2 inhibitors may be a common and underrecognized secondary cause of elevated hemoglobin levels in patients investigated for erythrocytosis. Our findings underscore the importance of a detailed medical history to support judicious use of molecular testing, in adherence with the current guideline on the investigation of erythrocytosis.
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Affiliation(s)
- Benjamin Chin-Yee
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maxim Matyashin
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ian Cheong
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Pratibha Bhai
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Alejandro Lazo-Langner
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ala Almanaseer
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eri Kawata
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michael A Levy
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Alan Stuart
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hanxin Lin
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ian Chin-Yee
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Bekim Sadikovic
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Cyrus Hsia
- Division of Hematology (B. Chin-Yee, Matyashin, Lazo-Langner, Almanaseer, I. Chin-Yee, Hsia), Department of Medicine, Schulich School of Medicine and Dentistry, Western University; Division of Hematology (B. Chin-Yee, Lazo-Langner, I. Chin-Yee, Hsia), Department of Medicine, London Health Sciences Centre; Department of Pathology and Laboratory Medicine (Cheong, Stuart, Lin, I. Chin-Yee, Sadikovic), Schulich School of Medicine and Dentistry, Western University; Molecular Diagnostic Division (Bhai, Levy, Stuart, Lin, Sadikovic) and Verspeeten Clinical Genome Centre (Bhai, Levy, Sadikovic), London Health Sciences Centre, London, Ont.; Department of Hematology (Kawata), Panasonic Health Insurance Organization, Matsushita Memorial Hospital, Osaka, Japan; Division of Hematology and Oncology (Kawata), Kyoto Prefectural University of Medicine, Kyoto, Japan
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Gaddam M, Prakash P, Devegowda D, Kumar R. Analysis of JAK2V617F Tyrosine Kinase Mutation in Blood Donors with Erythrocytosis - A Pilot Study in a Tertiary Care Teaching Hospital of South India. J Blood Med 2022; 13:439-446. [PMID: 35992633 PMCID: PMC9384845 DOI: 10.2147/jbm.s370687] [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: 04/13/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Transfusion services and blood centers provide immediate medical evaluation to blood donors by physical examination and hemoglobin (Hb) screening. Screening for Hb value before every blood donation is mainly aimed to rule out anemia. However, it is not uncommon to defer the donors for high Hb value which can be due to primary or secondary polycythemia. This study aimed to analyze the frequency of JAK2V617F mutation among blood donors with a high Hb of >18 g/dl. Patients and Methods A prospective study was conducted over a period of 18 months involving blood donors with a persistently high Hb value of >18 g/dl. Complete blood count (CBC), JAK2V617F gene mutation and Serum Erythropoietin (EPO) levels in study donors were analyzed. Descriptive statistical analysis was performed using SPSS, version 24 (IBM, USA). Results Of 13,798 screened donors, 48 donors (0.34%) had persistent erythrocytosis with a high Hb value of >18 g/dl. Their age ranged between 20-50 years with a mean of 31.2 ± 6.66. The CBC parameters including red blood cell (RBC) count, Hb%, hematocrit (Hct), white blood cell (WBC) count and the platelet count ranged from 4.35-8.43 million/µL (6.2 ± 0.6), 18.6-24.4 g/dl (19 ± 0.94), 51.9-83.3% (58 ± 5.02), 3.99-10.8 × 103/µL (7.8 ± 1.5), and 120-450 × 103/µL (227 ± 57.2), respectively. Estimated mean EPO value was 8.29 mIU/± 0.04. JAK2V617F mutation was detected in 2 donors (4.1%). Conclusion The prevalence of persistent erythrocytosis among blood donors was 0.34% and among them, two donors (4.1%) harbored the JAK2V617F mutation. Thus, blood centers play an important role in the primary screening of donors with high hemoglobin leading to early detection and management of polycythemia vera (PV).
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Affiliation(s)
- Manasa Gaddam
- Department of Pathology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
| | - Pallavi Prakash
- Transfusion Medicine and Blood Center, Department of Pathology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
| | - Devananda Devegowda
- Department of Biochemistry, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
| | - Ravindran Kumar
- Department of Microbiology, JSS Medical College, JSSAHER, Mysuru, Karnataka, India
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Sung SY, Chang YC, Wu HJ, Lai HC. Polycythemia-Related Proliferative Ischemic Retinopathy Managed with Smoking Cessation: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138072. [PMID: 35805729 PMCID: PMC9265410 DOI: 10.3390/ijerph19138072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023]
Abstract
Ischemic retinopathy characterized by neovascularization could result from several diseases such as proliferative diabetic retinopathy, hypertensive retinopathy, and retinal vein occlusion. However, ocular ischemic conditions caused by polycythemia have rarely been described. We report the first case of polycythemia-related proliferative ischemic retinopathy in a 41-year-old male heavy smoker who had ocular ischemic condition due to secondary polycythemia. He had sudden loss of vision in his right eye vision with vitreous hemorrhage and a tortuous retinal artery. Tracing back to his history, he was a heavy smoker with more than one pack of cigarettes per day for more than 30 years. Laboratory data revealed elevated levels of hemoglobin (17.7 g/dL) and hematocrit (51.6%) without other abnormal findings. We performed retinal photocoagulation on the neovascular areas and the fibrous membrane. Additionally, the patient was advised to quit smoking. Owing to adherence to this treatment, the patient’s vision gradually recovered. Although rare, polycythemia can cause retinal ischemic events and should be considered as a sight-threatening disease. Photocoagulation is effective on the regression of the neovascular lesion. Most importantly, changes in lifestyle together with smoking cessation are effective in managing secondary polycythemia. In conclusion, prevention and cessation of tobacco consumption helps improve vision health.
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Affiliation(s)
- Shao-Yu Sung
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung 80756, Taiwan; (S.-Y.S.); (Y.-C.C.); (H.-J.W.)
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung 80756, Taiwan; (S.-Y.S.); (Y.-C.C.); (H.-J.W.)
- Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Horng-Jiun Wu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung 80756, Taiwan; (S.-Y.S.); (Y.-C.C.); (H.-J.W.)
| | - Hung-Chi Lai
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung 80756, Taiwan; (S.-Y.S.); (Y.-C.C.); (H.-J.W.)
- Correspondence:
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王 金, 方 金, 谢 宇, 马 薇, 惠 培, 苏 晓, 郭 斌, 陈 雪, 王 旭, 范 杰, 赵 媛. [Analysis of related factors in secondary erythrocytosis of obstructive sleep apnea hypopnea syndrome in Gansu province]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:338-342. [PMID: 35483682 PMCID: PMC10128252 DOI: 10.13201/j.issn.2096-7993.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Objective:To analyze the related factors of secondary erythrocytosis of obstructive sleep apnea(OSA) in Gansu province. Methods:Polysomnography recording and analysis from January 2013 to January 2021, A total of 448 OSA patients of long-resident Han nationality in Gansu province. Hemoglobin(Hb) values were divided into group A(Hb 120-160 g/L) 41 cases, B(Hb 161-179 g/L) 142 cases, C(Hb 180-199 g/L) 152 cases, D(Hb 200-219 g/L) 79 cases, and E(Hb ≥220 g/L) 30 cases. General clinical data, altitude of residence, disease course, apnea hypopnea index (AHI), and Lowest oxyhemoglobin(LSpO₂) were compared among these groups. Multivariate regression and ROC curves were used to analyze the influencing factors of OSA secondary erythrocytosis. Results:There were no significant differences in age, sex, and course of disease among groups A, B, C, D, and E (P>0.05).The altitude of group E was higher than that of groups A, B, C, and D (P<0.05), but there was no significant difference between groups A, B, C and D (P>0.05).AHI was significantly different among groups A, B, C, D, and E (P<0.05), groups C, D, and E were significantly higher than A; group D was significantly higher than B, C.LSpO₂ was significantly different among groups A, B, C, D, and E (P <0.05), groups B, C, D, and E was significantly lower than A; group D, E was significantly lower than B, C.MSpO₂ was significantly different among groups A, B, C, D, and E (P<0.05), groups B, C, D, and E was significantly lower A; groups D, E was significantly lower than B , C.Multivariate regression showed that the higher the altitude, the lower the MSpO₂, the more serious the secondary hyperhemoglobinemia.Age, course of the disease, AHI, and LSpO₂ were not the influencing factors of OSA secondary hemoglobin increase.The areas under the ROC curve for MSpO₂ and altitude to predict Hb≥180 g/L were 0.694(P<0.001) and 0.570(P=0.009), with statistically significant differences(Z=3.205, P=0.001). Conclusion:Altitude and MSpO₂ were independent risk factors for OSA secondary erythrocytosis; MSpO₂ predicted that Hb≥180 g/L in OSA patients was better than altitude.
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Affiliation(s)
- 金凤 王
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 金瑞 方
- 甘肃省人民医院日间诊疗中心Department of Day Care Center, Gansu Provincial Hospital
| | - 宇平 谢
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 薇 马
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 培林 惠
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 晓燕 苏
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 斌 郭
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 雪萍 陈
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 旭斌 王
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 杰 范
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - 媛 赵
- 甘肃省人民医院睡眠医学中心(兰州,730000)Department of Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
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18
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Kandasamy D, Shastry S, O'Brien SF. Is high hemoglobin a hindrance factor for blood donation? A pilot observational study from the coastal region of India. Transfus Clin Biol 2022; 29:147-152. [PMID: 34856398 DOI: 10.1016/j.tracli.2021.11.002] [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] [Received: 10/21/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood donors with high Hb are often deferred for the presumed risk of polycythemia vera (PV). However, adequate data to substantiate or refute this hypothesis is lacking. METHODOLOGY We conducted an observational study on blood donors found to have high hemoglobin (Hb≥18g/dL) during the pre-donation screening process using a portable hemoglobinometer at our blood center for four months. We adopted a cost effective methodology wherein a questionnaire was used to elicit the secondary causative factors of high hemoglobin and a complete blood count test to observe the blood cell parameters and JAK2V617F mutation test was performed in a subset of donors lacking secondary erythrocytosis (SE) history. RESULTS Of the total 7076 donors enrolled, 112 male donors (1.58%) had high hemoglobin. The majority (70.4%) were repeat donors with mean age of 31.4 years. About 61% of the donors had attributable factors for SE like smoking, occupational exposure to carbon monoxide. The mean hemoglobin value of capillary and venous hemoglobin demonstrated a statistically significant difference (P<0.05) where 2.7% of donors had venous Hb<18g/dL. The hematological profile of all the donors showed increased RBC but normal platelet and WBC count. Of 24 donors included for the JAK2V617F test, none had a positive report. CONCLUSION This study suggests high hemoglobin in blood donors is less likely due to PV. Hence, re-considering their deferral may help alleviate donor anxiety and allow donor return. However, multi-centric studies are required to develop consensus statements on PV risk status and blood donation eligibility.
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Affiliation(s)
- D Kandasamy
- Department of Immunohematology & Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - S Shastry
- Department of Immunohematology & Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - S F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada.
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19
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Chin‐Yee B, Cheong I, Matyashin M, Lazo‐Langner A, Chin‐Yee I, Bhayana V, Bhai P, Lin H, Sadikovic B, Hsia CC. Serum erythropoietin levels in 696 patients investigated for erythrocytosis with JAK2 mutation analysis. Am J Hematol 2022; 97:E150-E153. [PMID: 35045195 DOI: 10.1002/ajh.26471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Benjamin Chin‐Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
| | - Ian Cheong
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Maxim Matyashin
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
| | - Alejandro Lazo‐Langner
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
| | - Ian Chin‐Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Pratibha Bhai
- Molecular Diagnostic Division London Health Sciences Centre London Ontario Canada
- Verspeeten Clinical Genome Centre London Health Sciences Centre London Ontario Canada
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Molecular Diagnostic Division London Health Sciences Centre London Ontario Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Molecular Diagnostic Division London Health Sciences Centre London Ontario Canada
- Verspeeten Clinical Genome Centre London Health Sciences Centre London Ontario Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
- Division of Hematology, Department of Medicine London Health Sciences Centre London Ontario Canada
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20
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Potential limitations of diagnostic standard codes to distinguish polycythemia vera and secondary erythrocytosis. Sci Rep 2022; 12:4674. [PMID: 35304527 PMCID: PMC8933419 DOI: 10.1038/s41598-022-08606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Red cell overproduction is seen in polycythemia vera (PV), a bone marrow myeloproliferative neoplasm characterized by trilinear cell proliferation (WBC, platelets), as well as in secondary erythrocytosis (SE), a group of heterogeneous disorders characterized by elevated EPO gene transcription. We aimed to verify the concordance of the International Classification of Diseases (ICD) code-based diagnosis of “polycythemia” or “erythrocytosis” with the true clinical diagnosis of these conditions. We retrospectively reviewed the electronic medical records (January 1, 2005, to December 31, 2016) of adult patients with ICD codes of polycythemia and/or erythrocytosis who had testing done for the presence of the JAK2V617F mutation. We verified the accuracy of the ICD code-based diagnoses by meticulous chart review and established whether these patients fulfilled the criteria by the evaluating physician for PV or SE and according to the World Health Organization 2016 diagnostic guidelines. The reliability of ICD coding was calculated using Cohen's kappa. We identified and chart reviewed a total of 578 patient records. Remarkably, 11% of the patients had concurrent diagnosis codes for PV and SE and were unable to be classified appropriately without individual chart review. The ICD code-based diagnostic system led to misidentification in an important fraction of cases. This represents a problem for the detection of PV or SE cases by ICD-based registries and their derived studies. Research based exclusively on ICD codes could have a potential impact on patient care and public health, and limitations must be weighed when research findings are conveyed.
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21
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Schena FP, Cox SN. New directions in the pathogenesis of primary erythrocytosis in IgAN. EBioMedicine 2022; 76:103834. [PMID: 35078011 PMCID: PMC8792066 DOI: 10.1016/j.ebiom.2022.103834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Sharon Natasha Cox
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Bari, Italy
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22
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Evans A, Songtanin B, Nugent K. The Gaisbock syndrome after COVID-19 pneumonia. Proc AMIA Symp 2022; 35:207-208. [DOI: 10.1080/08998280.2021.2022370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Abbie Evans
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Busara Songtanin
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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23
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Zeng Z, Song Y, He X, Yang H, Yue F, Xiong M, Hu K. Obstructive Sleep Apnea is Associated with an Increased Prevalence of Polycythemia in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2022; 17:195-204. [PMID: 35068930 PMCID: PMC8769057 DOI: 10.2147/copd.s338824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are associated with polycythemia. However, there still remain unanswered questions about the relationship between overlap syndrome (OVS), where OSA and COPD coexist, and polycythemia. Here, we aimed to establish the prevalence of polycythemia in OVS patients and to explore the impact of OSA on polycythemia. Patients and Methods Patients with COPD underwent overnight polysomnography (PSG), pulmonary function tests, echocardiography, and complete blood counts. All patients were ethnic Han Chinese and free of prolonged oral corticosteroid use, hematological system disease, severe systemic disease, and other sleep-disordered breathing. OVS was defined as COPD patients with an apnea–hypopnea index ≥15 events/h, and polycythemia was defined as an Hb >165 g/L in men and >160 g/L in women. Results Eight-hundred and eighty-six patients with COPD were included in the analysis. The prevalence of polycythemia was significantly higher in OVS patients than COPD-alone patients (6.4% vs 2.9%, p < 0.05). The prevalence of polycythemia increased with OSA severity (χ2 = 7.885, p = 0.007), but not in GOLD grade 3–4 COPD patients (χ2 = 0.190, p = 0.663). After adjusting for confounders, percentage of total sleep time with SaO2 <90% (TS90) remained independently associated with an increased odds of polycythemia (OR 1.030, 95% CI 1.015–1.046) and, with an increase in TS90, the hemoglobin increased, especially in GOLD grade 1–2 patients (p < 0.05). Conclusion Patients with OVS have a higher prevalence of polycythemia than those with COPD alone, and TS90 is an independent factor for polycythemia, especially in GOLD1-2 COPD patients.
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Affiliation(s)
- Zhaofu Zeng
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Yan Song
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Xin He
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Haizhen Yang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Fang Yue
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People’s Republic of China
- Correspondence: Ke Hu Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of ChinaTel +86 1897 103 5988 Email
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24
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Schumacher KA, Gosmanov AR. Hemochromatosis Gene Mutation in Persons Developing Erythrocytosis on Combined Testosterone and SGLT-2 Inhibitor Therapy. J Investig Med High Impact Case Rep 2022; 10:23247096221111774. [PMID: 35848311 PMCID: PMC9290160 DOI: 10.1177/23247096221111774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/03/2022] [Accepted: 06/18/2022] [Indexed: 01/10/2023] Open
Abstract
In clinical trials, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) use alone in persons with type 2 diabetes (T2D) or testosterone replacement therapy (TRT) prescription alone in men with hypogonadism was shown to lead to a modest but significant increase in red blood cell mass. Recent evidence indicates that combined use of TRT and SGLT-2i in persons with T2D may be associated with risk of erythrocytosis. However, factor(s) that may lead to the development of erythrocytosis in these patients is unknown. We describe here 5 consecutive patients with hypogonadism on chronic TRT who developed erythrocytosis following addition of SGLT-2i empagliflozin for optimization of T2D management. In addition to the careful review of medical history, all patients underwent genetic screening for hereditary hemochromatosis. We have found that none of the patients had C282Y mutation in the HFE (Homeostatic Iron Regulator) gene and 4 out of 5 patients had heterozygosity in the H63D allele. Upon TRT discontinuation or its dose reduction or referral for scheduled phlebotomy, patients showed resolution of erythrocytosis. Our study reaffirms that practitioners should monitor for changes in hematocrit following the initiation of SGLT-2i in persons with T2D and hypogonadism on chronic TRT. Also, for the first time, we showed that in some of the patients receiving combined TRT and SGLT-2i H63D heterozygosity in the HFE gene may mediate the development of new-onset erythrocytosis.
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Affiliation(s)
| | - Aidar R. Gosmanov
- Albany Medical College, NY, USA
- Albany Stratton VA Medical Center, NY, USA
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25
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Tesfamariam S, Ghebrenegus AS, Woldu H, Fisseha E, Belai G, Russom M. Secondary erythrocytosis following drugs used in rifampicin/multidrug-resistant tuberculosis: a retrospective cohort study. BMJ Open Respir Res 2021; 8:8/1/e001064. [PMID: 34815231 PMCID: PMC8611426 DOI: 10.1136/bmjresp-2021-001064] [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: 07/24/2021] [Accepted: 11/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) drugs have never been associated with erythrocytosis. In Eritrea, however, several cases of incident erythrocytosis had been observed in the MDR-TB hospital. This study was aimed at exploring the association between MDR-TB drugs and secondary erythrocytosis, characterising the cases, and identifying other possible risk factors. Methods A retrospective cohort study was conducted in Merhano National Referral MDR-TB hospital. Data were extracted from physically available clinical cards and laboratory results collected longitudinally between 23 June 2011 and 17 January 2021. Initially, univariate descriptive statistics (frequency, mean (SD), median (IQR) and range) were used as appropriate. Then, χ2 or Fisher χ2 test, and bivariate and/or multivariate Cox proportional hazard model were used to identify the predictors of incident erythrocytosis. All statistical analyses were conducted using R, and a two-sided alpha 0.05 was used to determine the statistical significance. Results A total of 257 patients’ medical cards were screened, and 219 were eligible for further analysis. The median age of the patients was 38 years (range: 13–90 years) and 54.8% were males. During the follow-up time, 31 (14.2%) patients developed secondary erythrocytosis yielding an incidence rate of 7.8 cases per 1000 person-months. On average, the median time to onset of the event was found to be 5-months (range: 1–24 months). Males were more likely to develop the event than females (adjusted HR=7.13, 95% CI=1.66 to 30.53), and as body weight increases by 1 kg, the likelihood of developing secondary erythrocytosis was found to increase by 7% (adjusted HR=1.07, 95% CI=1.03 to 1.10). Moreover, all cases of secondary erythrocytosis were found to be possibly associated with the MDR-TB drugs. Conclusion The authors hypothesised that the incident erythrocytosis is possibly be associated with MDR-TB drugs, and further studies are required to substantiate this finding.
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Affiliation(s)
- Sirak Tesfamariam
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Asmara, Eritrea
| | | | - Henok Woldu
- The Center for Health Analytics for National and Global Equity (C.H.A.N.G.E), Columbia, Missouri, USA
| | - Ephrem Fisseha
- Eritrean Air-Force Military Hospital, Asmara, Eritrea.,Merhano National Referral MDR-TB Hospital, Asmara, Eritrea
| | | | - Mulugeta Russom
- Eritrean Pharmacovigilance Center, National Medicines and Food Administration, Asmara, Eritrea.,Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands.,European Programme for Pharmacovigilance and Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
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26
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Olivas-Martinez A, Corona-Rodarte E, Nuñez-Zuno A, Barrales-Benítez O, Oca DMMD, Mora JDDL, León-Aguilar D, Hernández-Juárez HE, Tuna-Aguilar E. Causes of erythrocytosis and its impact as a risk factor for thrombosis according to etiology: experience in a referral center in Mexico City. Blood Res 2021; 56:166-174. [PMID: 34462407 PMCID: PMC8478616 DOI: 10.5045/br.2021.2021111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background Thrombotic events are well documented in primary erythrocytosis, but it is uncertain if secondary etiologies increase the risk of thrombosis. This study aimed to determine the causes of erythrocytosis and to identify its impact as a risk factor for thrombosis. Methods Data were obtained from patients with erythrocytosis between 2000 and 2017 at a referral hospital in Mexico City. Erythrocytosis was defined according to the 2016 WHO classification. Time to thrombosis, major bleeding, or death were compared among groups of patients defined by the etiology of erythrocytosis using a Cox regression model, adjusting for cardiovascular risk factors. Results In total, 330 patients with erythrocytosis were studied. The main etiologies of erythrocytosis were obstructive sleep apnea (OSA) in 29%, polycythemia vera (PV) in 18%, and chronic lung disease (CLD) in 9.4% of the patients. The incidence rate of thrombosis was significantly higher in patients with PV and CLD than that in patients with OSA (incidence rates of 4.51 and 6.24 vs. 1.46 cases per 100 person-years, P=0.009), as well as the mortality rate (mortality rates of 2.72 and 2.43 vs. 0.17 cases per 100 person-years, P =0.003). Conclusion The risk of thrombosis in CLD with erythrocytosis was comparable to that in patients with PV. Further larger-scale studies are needed to confirm these findings and evaluate the benefits of preventive management of COPD with erythrocytosis similar to PV.
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Affiliation(s)
- Antonio Olivas-Martinez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Eduardo Corona-Rodarte
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Adrián Nuñez-Zuno
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México
| | - Olga Barrales-Benítez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Jesús Delgado-de la Mora
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana León-Aguilar
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hilda Elizeth Hernández-Juárez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elena Tuna-Aguilar
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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27
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Kodaira S, Ehara J, Takamizawa S, Ogita S, Norisue Y, Nakama T, Hiraoka E. Acute Lower Extremity Arterial Thrombosis Associated with Osimertinib-Induced Erythrocytosis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932252. [PMID: 34491978 PMCID: PMC8436826 DOI: 10.12659/ajcr.932252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 70-year-old
Final Diagnosis: Drug induced polycythemia
Symptoms: Sural pain
Medication: —
Clinical Procedure: Endovascular treatment
Specialty: Oncology • Pulmonology
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Affiliation(s)
- Shota Kodaira
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Jun Ehara
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan.,Department of Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Shigemasa Takamizawa
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Shin Ogita
- Department of Medical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuhiro Norisue
- Department of Pulmonary Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
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Aylan Gelen S, Sarper N, Zengin E, Tahsin İ, Azizoğlu M. Clinical Characteristics of Pediatric Patients with Congenital Erythrocytosis: A Single-Center Study. Indian J Hematol Blood Transfus 2021; 38:366-372. [PMID: 35496967 PMCID: PMC9001768 DOI: 10.1007/s12288-021-01484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Although congenital erythrocytosis (CE), an inherited disorder, impairs pediatric quality of life, physicians often overlook high hemoglobin (Hgb) levels and its symptoms due to lack of knowledge of age-adjusted pediatric Hgb levels and CE's rarity. In a retrospective, single-center study, data from hospital records of pediatric patients diagnosed with CE were evaluated. Twenty-six patients from 25 families (80.8% male) had been diagnosed with CE in 20 years, at a mean age of 14.9 ± 2.8 years (8.3-17.8) and with a mean Hgb level of 17.36 ± 1.44 g/dL (14.63-22.1). No serum erythropoietin levels exceeded the reference levels. Although the most common symptom was headache (85%), 38% of patients presented with at least one gastrointestinal symptom (e.g., nausea, vomiting, abdominal pain, and rectal bleeding), and 54% exhibited plethora. No patient had leukocytosis, thrombocytosis, JAK2 mutation; capillary oxygen saturation, venous blood gas analysis, and Hgb electrophoresis revealed no abnormalities. While 34.6% of patients had family histories of CE, 42.3% had 15-45-year-old relatives who had experienced myocardial infarction, stroke, and/or sudden death. Aspirin was routinely prescribed, and phlebotomy was performed when hyperviscosity symptoms were present. To detect CE, physicians should consider age-adjusted normal Hgb levels in children. Pediatric patients with CE may also present with gastrointestinal symptoms. Although no thrombotic episode occurred among the patients, their family histories included life-threatening thrombotic episodes, even in adolescents.
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Affiliation(s)
- Sema Aylan Gelen
- Division of Pediatric Hematology, Department of Pediatrics, Kocaeli University, Umuttepe, 41380 Kocaeli, Turkey
| | - Nazan Sarper
- Division of Pediatric Hematology, Department of Pediatrics, Kocaeli University, Umuttepe, 41380 Kocaeli, Turkey
| | - Emine Zengin
- Division of Pediatric Hematology, Department of Pediatrics, Kocaeli University, Umuttepe, 41380 Kocaeli, Turkey
| | - İnci Tahsin
- Division of Pediatric Hematology, Department of Pediatrics, Kocaeli University, Umuttepe, 41380 Kocaeli, Turkey
| | - Mehmet Azizoğlu
- Division of Pediatric Hematology, Department of Pediatrics, Kocaeli University, Umuttepe, 41380 Kocaeli, Turkey
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Mamedova EO, Selivanova LS, Potapova KA, Buryakina SA, Azizyan VN, Grigoriev AY, Belaya ZE. [A rare case of a functioning gonadotroph tumor accompanied by erythrocytosis in an elderly man]. ACTA ACUST UNITED AC 2021; 67:37-44. [PMID: 34297500 DOI: 10.14341/probl12758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/13/2021] [Indexed: 11/06/2022]
Abstract
Functioning gonadotroph adenomas are rare pituitary tumors secreting one or two gonadotropins (follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH)), which are hormonally active. In the majority of cases, gonadotroph tumors are endocrinologically "silent" and make up more than a half of non-functioning pituitary adenomas. In this article we describe a rare clinical case of LH/FSH-secreting pituitary macroadenoma with bitemporal hemianopsia in a 62-year-old man. The patient underwent transnasal transsphenoidal adenomectomy, leading to remission. The distinctive feature of this case is the presence of secondary erythrocytosis due to endogenous hyperandrogenism, which required several blood exfusions to normaliza the level of hematocrit before surgery. It is noteworthy that clinical signs of erythrocytosis were present long before visual impairment. This clinical case demonstrates difficulties in the early diagnosis of functioning gonadotroph adenomas.
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30
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Montada-Atin T, Prasad GVR. Recent advances in new-onset diabetes mellitus after kidney transplantation. World J Diabetes 2021; 12:541-555. [PMID: 33995843 PMCID: PMC8107982 DOI: 10.4239/wjd.v12.i5.541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
A common challenge in managing kidney transplant recipients (KTR) is post-transplant diabetes mellitus (PTDM) or diabetes mellitus (DM) newly diagnosed after transplantation, in addition to known pre-existing DM. PTDM is an important risk factor for post-transplant cardiovascular (CV) disease, which adversely affects patient survival and quality of life. CV disease in KTR may manifest as ischemic heart disease, heart failure, and/or left ventricular hypertrophy. Available therapies for PTDM include most agents currently used to treat type 2 diabetes. More recently, the use of sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and dipeptidyl peptidase 4 inhibitors (DPP4i) has cautiously extended to KTR with PTDM, even though KTR are typically excluded from large general population clinical trials. Initial evidence from observational studies seems to indicate that SGLT2i, GLP-1 RA, and DPP4i may be safe and effective for glycemic control in KTR, but their benefit in reducing CV events in this otherwise high-risk population remains unproven. These newer drugs must still be used with care due to the increased propensity of KTR for intravascular volume depletion and acute kidney injury due to diarrhea and their single-kidney status, pre-existing burden of peripheral vascular disease, urinary tract infections due to immunosuppression and a surgically altered urinary tract, erythrocytosis from calcineurin inhibitors, and reduced kidney function from acute or chronic rejection.
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Affiliation(s)
- Tess Montada-Atin
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, Ontario, Canada
| | - G V Ramesh Prasad
- Kidney Transplant Program, St. Michael's Hospital, Toronto M5C 2T2, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto M5C 2T2, Canada
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31
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Chin-Yee B, Solh Z, Hsia C. Erythrocytosis induced by sodium-glucose cotransporter-2 inhibitors. CMAJ 2020; 192:E1271. [PMID: 33077524 PMCID: PMC7588208 DOI: 10.1503/cmaj.76686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Benjamin Chin-Yee
- Clinical fellow, Division of Hematology, Department of Medicine, Western University, London, Ont
| | - Ziad Solh
- Assistant professor, Pathology and Laboratory Medicine, Western University, London, Ont
| | - Cyrus Hsia
- Associate professor, Division of Hematology, Department of Medicine, Western University, London, Ont
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