Incidence of Silent Thrombosis in Patients Younger Than 60 Years With Myeloproliferative Neoplasms: Single-Center Egyptian Study

BACKGROUND

Identification of janus kinase 2 (JAK2) mutation even in absence of myeloproliferative disorders (MPNs) was found to be related to venous thromboembolism occurrence. Venous thrombosis screening is not routinely requested in patients with myeloproliferative neoplasms unless the patient is symptomatic. It has been reported that the incidence of thrombosis in elderly patients is much higher than in young patients. The aim of this work was to screen MPN patients for venous thrombosis and study its correlation with JAK2 allele burden and with MPN 10 score.

PATIENTS AND METHODS

We enrolled 73 patients with JAK2-positive MPN from our Hematology Clinic in the period August 2015 to Feb 2017. All patients had been screened for thrombosis in the venous system in lower limbs (LLs), upper limbs, portal, and mesenteric systems using color Doppler ultrasound imaging.

RESULTS

Fifty-three (72.6%) patients were younger than 60 years. Twenty-two (30%) had essential thrombocytosis, 35 (47.9%) had polycythemia rubra vera, and 16 (22%) had idiopathic myelofibrosis. Twenty-seven venous thrombotic attacks were reported in 22 (30.1%) patients. Five (6.8%) had thrombosis in 2 sites. Seventeen (23%) had superior mesenteric and portal vein thrombosis. Six (8%) had iliofemoral (8%) and 4 (5%) had combined LL and portal thrombosis. Eight (10.8%) had active thrombosis at screening. Only 3 patients (4%) were symptomatic with abdominal pain during screening. Pruritis (P = .02) and abdominal pain (P = .039) were significantly different between cases with and without thrombosis. There was no significant difference in MPN 10 score between cases with active or previous thrombosis.

CONCLUSION

We recommend routine screening for venous thrombosis in any case of MPN when diagnosed and screening for MPNs in any patient with venous thrombosis especially of the portal vein or atypical sites. If MPN patients present with increasing pruritus or abdominal pain, they also should be screened for venous thrombosis. Further research on a large scale in MPN age groups younger than 60 years regarding pathogenesis of thrombosis is highly recommended.

Serum nickel concentration in normal menstrual cycle and after combined contraceptive pill

Serum nickel concentration in the different phases of the menstrual cycle and after use of a combined contraceptive pill (Anovlar) was determined by atomic absorption spectrophotometry. Twenty ovulating females had their serum nickel level measured on day 5 and on day 27 of their cycle. Forty females using Anovlar for 6 months and 40 females using it for more than 3 years had their serum nickel determined. The serum nickel concentration of the non-pill users was higher on day 5 (2.52 +/- 0.46 micrograms/L) than on day 27 (2.21 +/- 0.37 micrograms/L p less than 0.05). In long-term users, the serum nickel (0.98 +/- 0.38 microgram/L) was less than the short-term users (2.38 +/- 0.35 micrograms/L, p less than 0.01) and the non-users (p less than 0.01). There was a negative correlation between the duration of pill use and the serum nickel level (r = -0.44, p less than 0.01). The significance of the decreased serum nickel level with long-term pill use remains to be determined.

Group B-beta haemolytic streptococcal colonization in women using intrauterine contraceptive devices

Two-hundred-and-eighteen gynaecological patients were screened for group B-beta haemolytic streptococci (GBS) colonization of the vagina, cervix, urethra and rectum. The overall colonization rate was 17%. There is no relation between the rate of colonization and the patient's age or parity. The colonization rate among the intrauterine contraceptive device (IUCD) users (31%) is significantly higher than the non-users (14.5%). The IUCD does not cause GBS vaginal colonization. Nevertheless, its presence helps the microorganisms' vertical spread through the cervical canal. The short duration of IUCD use among the Saudi patients may have provided a protective mechanisms against the development of PID. All the four sites were colonized in the IUCD users and only in 8.1% of the non-users. The urethra was the most common site involved in both groups (83.8%). A higher incidence of GBS colonization was found among patients presenting with excessive vaginal discharge as the main complaint. The presence of excessive vaginal discharge is a significant factor towards the spread of the microorganism to the cervix and urethra. Therefore, an IUCD user with excessive vaginal discharge has a higher chance of getting cervical and urethral colonization.