An underestimated blood parameter before myeloproliferative neoplasm diagnosis: the case of thrombocytosis and the delayed essential thrombocytemia diagnosis
An underestimated blood parameter before myeloproliferative neoplasm diagnosis: the case of thrombocytosis and the delayed essential thrombocytemia diagnosis(375 views)(PDF public144 views) Martinelli V, Cella L, Pugliese N, Cappuccio I, Scognamiglio IR, Marano L, Simeone L, Campagna G, Picardi M, Pane F
Keywords: Essential Thrombocythemia, General Practitioner, Platelet Count, Thrombocytosis, Adolescent, Adult, Age Distribution, Article, Cancer Diagnosis, Cardiovascular Disease, Controlled Study, Delayed Diagnosis, Diagnostic Error, Female, Human, Major Clinical Study, Malpractice, Medical History, Myelofibrosis, Myeloproliferative Neoplasm, Receiver Operating Characteristic, Sex Difference, Splenomegaly, Thrombocyte Count, Very Elderly,
Affiliations: *** IBB - CNR ***
Hematology Unit, Department of Clinical Medicine and Surgery, Federico II Medical School, Naples, Italy
Institute of Biostructure and Bioimaging, National Research Council (CNR), Naples, Italy
References: Ross, D.W., Ayscue, L.H., Watson, J., Bentley, S.A., Stability of hematologic parameters in healthy subjects. Intraindividual versus interindividual variation (1988) Am. J. Clin. Pathol, 90, pp. 262-26
Sacchi, S., Vinci, G., Gugliotta, L., Diagnosis of essential thrombocythemia at platelet counts between 400 and 600x10(9)/L. Gruppo Italiano Malattie Mieloproliferative Croniche (GIMMC) (2000) Haematologica, 85, pp. 492-495
Baxter, E.J., Scott, L.M., Campbell, P.J., Cancer Genome Project. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders (2005) Lancet, 365, pp. 1054-1061
Levine, R.L., Pardanani, A., Tefferi, A., Gilliland, D.G., Role of JAK2 in the pathogenesis and therapy of Myeloproliferative disorders (2007) Nat. Rev. Cancer, 7, pp. 623-683
Klampfl, T., Gisslinger, H., Harutyunyan, A.S., Somatic mutations of calreticulin in myeloproliferative neoplasms (2013) N. Engl. J. Med, 369, pp. 2379-2390
Nangalia, J., Massie, C.E., Baxter, E.J., Somatic CARL mutations in myeloproliferative neoplasms with nonmutated JAK2 (2013) N. Engl. J. Med, 369, pp. 2391-2405
Rumi, E., Pietra, D., Ferretti, V., Associazione Italiana per la Ricerca sul Cancro Gruppo Italiano Malattie Mieloproliferative Investigators. JAK2 or CARL mutation status defines subtypes of essential thrombocythemia with substantially different clinical course and outcomes (2014) Blood, 123, pp. 1544-1551
Biino, G., Santimone, I., Minelli, C., Age- and sex-related variations in platelet count in Italy: A proposal of reference ranges based on 40987 subjects' data (2013) PLoS One, 8, p. e54289
Epstein, E., Goedel, A., Hämorrhagische Thrombozythämie bei vascularer Schrumpfmilz (1934) Virchows Archiv. A. Pathol. Anat. Histopathol, 293, p. 233
Dameshek, W., Some speculations on the Myeloproliferative Syndromes (1951) Blood, 6, pp. 372-375
Mesa, R.A., Silverstein, M.N., Jacobsen, S.J., Wollen, P.C., Tefferi, A., Population-based incidence and survival figures in essential thrombocythemia and agnogenic myeloid metaplasia: An Olmsted County Study, 1976-1995 (1999) Am. J. Hematolo, 61, pp. 10-15
Beatrice, J.M., Garanito, M.P., Essential thrombocythemia: A rare disease in childhood (2013) Rev. Bras. Hematol. Hemoter, 35, pp. 287-289
Turhan, A.G., Cashman, J.D., Eaves, C.J., Humphries, R.K., Eaves, A.C., Variable expression of features of normal and neoplastic stem cells in patients with thrombocytosis (1992) Br. J. Haematol, 82, pp. 50-57
El Kassar, N., Hetet, G., Briere, J., Grandchamp, B., Clonality analysis of hematopoiesis in essential thrombocythaemia: Advantages of studying T lymphocytes and platelets (1997) Blood, 89, pp. 128-134
Colombi, M., Radaelli, F., Zocchi, L., Maiolo, A.T., Thrombotic and hemorrhagic complications in essential thrombocythemia. A retrospective study of 103 patients (1991) Cancer, 67, pp. 2926-2930
Jensen, M.K., De Nully Brown, P., Nielsen, O.J., Hasselbalch, H.C., Incidence, clinical features and outcome of essential thrombocythaemia in a well-defined geographical area (2000) Eur. J. Haematol, 65, pp. 132-139
Vardiman, J.W., Thiele, J., Arber, D.A., The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: Rationale and important changes (2009) Blood, 114, pp. 937-951
Picardi, M., Martinelli, V., Ciancia, R., Measurement of spleen volume by ultrasound scanning in patients with thrombocytosis: A prospective study (2002) Blood, 99, pp. 4228-4230
Thiele, J., Kvasnicka, H.M., Grade of bone marrow fibrosis is associated with relevant hematological findings-A clinicopathological study on 865 patients with chronic idiopathic myelofibrosis (2006) Ann. Hematol, 85, pp. 226-232
Enblom, A., Lindskog, E., Hasselbalch, H., High rate of abnormal blood values and vascular complications before diagnosis of myeloproliferative neoplasms (2015) Eur. J. Med, 26, pp. 344-347
Tefferi, A., Barbui, T., Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management (2015) Am. J. Hematol, 90, pp. 162-173
An underestimated blood parameter before myeloproliferative neoplasm diagnosis: the case of thrombocytosis and the delayed essential thrombocytemia diagnosis
Background: Thrombocytosis, i.e. platelet count >
400.000/μL in
peripheral blood, is also due to Essential Thrombocythemia (ET), and
delaying the diagnosis of thrombocytosis might coincide with a delayed
ET diagnosis. The purpose of our study was to investigate the factors
virtually leading to a delay in ET diagnosis.
Methods: We analyzed the interval between the first evidence of
thrombocytosis and ET diagnosis, and defined it as ETunderestimation-
period (ET-uP). We analyzed 280 ET patients followed at our Institution.
To verify possible correlations with ET-uP, we investigated patients’
ages, gender, history of vascular complications, thrombocytosis,
splenomegaly, and marrow fibrosis degree. We also considered their
General Practitioners (GP) characteristics: age, personal computer use,
number of patient visits in the two years before diagnosis. Univariate
logistic analysis for each parameter was performed using the Spearman’s
rank correlation coefficient to assess correlation with ET-uP.
Multivariate logistic regression analysis was performed on the
parameters that resulted significant at the previous analyses. The
logistic regression analysis was performed dichotomizing the ET-uP
variable using its median value.
Results: Median ET-uP was 16 months (range 1-240). The analysis
showed that a shorter ET-uP correlated with thrombocytosis (p<0.001)
and previous cardiovascular events (p=0.04). At multivariate analysis,
the Area. Under the Curve (AUC) of the (Receiver Operating
Characteristic) ROC curve was 0.72. No correlation was found analyzing
GP data.
Conclusion: Our results underline a deficient medical practice, and
prompt for corrective actions (use of more restrictive normal range for
platelet count–with lower upper limit and warning flags for pathological
findings) to timely commence the diagnostic workup of this condition.
An underestimated blood parameter before myeloproliferative neoplasm diagnosis: the case of thrombocytosis and the delayed essential thrombocytemia diagnosis
No results.
An underestimated blood parameter before myeloproliferative neoplasm diagnosis: the case of thrombocytosis and the delayed essential thrombocytemia diagnosis
Kim YH, Shin SW, Pellicano R, Fagoonee S, Choi IJ, Kim YI, Park B, Choi JM, Kim SG, Choi J, Park JY, Oh S, Yang HJ, Lim JH, Im JP, Kim JS, Jung HC, Ponzetto A, Figura N, Malfertheiner P, Choi IJ, Kook MC, Kim YI, Cho SJ, Lee JY, Kim CG, Park B, Nam BH, Bae SE, Choi KD, Choe J, Kim SO, Na HK, Choi JY, Ahn JY, Jung KW, Lee J, Kim DH, Chang HS, Song HJ, Lee GH, Jung HY, Seta T, Takahashi Y, Noguchi Y, Shikata S, Sakai T, Sakai K, Yamashita Y, Nakayama T, Leja M, Park JY, Murillo R, Liepniece-karele I, Isajevs S, Kikuste I, Rudzite D, Krike P, Parshutin S, Polaka I, Kirsners A, Santare D, Folkmanis V, Daugule I, Plummer M, Herrero R, Tsukamoto T, Nakagawa M, Kiriyama Y, Toyoda T, Cao X, Corral JE, Mera R, Dye CW, Morgan DR, Lee YC, Lin JT, Garcia Martin R, Matia Cubillo A, Lee SH, Park JM, Han YM, Ko WJ, Hahm KB, Leontiadis GI, Ford AC, Ichinose M, Sugano K, Jeong M, Park JM, Han YM, Park KY, Lee DH, Yoo JH, Cho JY, Hahm KB, Bang CS, Baik GH, Shin IS, Kim JB, Suk KT, Yoon JH, Kim YS, Kim DJ * Helicobacter pylori Eradication for Prevention of Metachronous Recurrence after Endoscopic Resection of Early Gastric Cancer(297 views) N Engl J Med (ISSN: 0028-4793, 0028-4793linking, 1533-4406electronic), 2015 Jun; 30642104201566393291: 749-756. Impact Factor:59.558 ViewExport to BibTeXExport to EndNote