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Jalowiec KA, Vrotniakaite-Bajerciene K, Jalowiec J, Frey N, Capraru A, Wojtovicova T, Joncourt R, Angelillo-Scherrer A, Tichelli A, Porret NA, Rovó A. JAK2 Unmutated Polycythaemia-Real-World Data of 10 Years from a Tertiary Reference Hospital. J Clin Med 2022; 11:jcm11123393. [PMID: 35743463 PMCID: PMC9225037 DOI: 10.3390/jcm11123393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Polycythaemia is defined by an increase in haemoglobin (Hb) concentration, haematocrit (Hct) or red blood cell (RBC) count above the reference range adjusted to age, sex and living altitude. JAK2 unmutated polycythaemia is frequent but under-investigated in original publications. In this retrospective cohort study, we investigated the clinical and laboratory data, underlying causes, management and outcomes of JAK2 unmutated polycythaemia patients. (2) Methods: The hospital database was searched to identify JAK2 unmutated patients fulfilling WHO 2016 Hb/Hct criteria for PV (Hb >16.5 g/dL in men and >16 g/dL in women, or Hct > 49% in men and >48% in women, or RBC mass > 25% above mean normal predicted value) between 2008 and 2019. Clinical and laboratory data were collected and analysed. (3) Results: From 727,731 screened patients, 294 (0.04%) were included, the median follow-up time was 47 months. Epo and P50 showed no clear pattern in differentiating causes of polycythaemia. In 30%, the cause remained idiopathic, despite extensive work-up. Sleep apnoea was the primary cause, also in patients under 30. Around 20% had received treatment at any time, half of whom had ongoing treatment at the end of follow-up. During follow-up, 17.2% developed a thromboembolic event, of which 8.5% were venous and 8.8% arterial. The mortality was around 3%. (4) Conclusions: Testing for Epo and P50 did not significantly facilitate identification of underlying causes. The frequency of sleep apnoea stresses the need to investigate this condition. Idiopathic forms are common. A diagnostic flowchart based on our data is proposed here. NGS testing should be considered in young patients with persisting polycythaemia, irrespective of Epo and P50 levels.
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Affiliation(s)
- Katarzyna Aleksandra Jalowiec
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
- Correspondence:
| | - Kristina Vrotniakaite-Bajerciene
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | | | - Noel Frey
- IDSC Insel Data Science Center, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland;
| | - Annina Capraru
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Tatiana Wojtovicova
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Raphael Joncourt
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Anne Angelillo-Scherrer
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Andre Tichelli
- Haematology, University Hospital of Basel, 4031 Basel, Switzerland;
| | - Naomi Azur Porret
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
| | - Alicia Rovó
- Department of Haematology and Central Haematology Laboratory, University Hospital/Inselspital Bern, University of Bern, 3010 Bern, Switzerland; (K.V.-B.); (A.C.); (T.W.); (R.J.); (A.A.-S.); (N.A.P.); (A.R.)
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Pearson TC, Messinezy M. Polycythaemia and thrombocythaemia in the elderly. BAILLIERE'S CLINICAL HAEMATOLOGY 1987; 1:355-87. [PMID: 3322442 DOI: 10.1016/s0950-3536(87)80006-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The investigation of elderly patients presenting with raised PCV values has been described. Suitable clinical and laboratory investigation enables the separation of those with a raised red cell mass (RCM) into three groups: primary proliferative polycythaemia (PPP), secondary polycythaemia and idiopathic erythrocytosis. Those patients with a raised PCV but normal RCM either have apparent polycythaemia (normal plasma volume) or relative polycythaemia (low plasma volume). PPP is a clonal disorder with a peak incidence in the elderly. It commonly presents with vascular occlusive symptoms/signs involving larger vessels, both arterial and venous. The microvasculature may also be involved, particularly when there is associated thrombocythaemia. Effective treatment is required to minimize the future vascular occlusive incidence and diminish the complication rate of surgery if it is ever required. Both the PCV and the platelet count, if elevated, should be adequately controlled. 32P is probably the simplest treatment and is very effective, but venesection and intermittent low-dose busulphan is equally satisfactory in the co-operative patient with good peripheral veins. Secondary polycythaemia may arise from a variety of causes, particularly from arterial hypoxaemia and renal lesions. Occasionally, more than one pathology is identified in the elderly patient. Lung disease is the most common cause of hypoxaemia. Venesection may be indicated in those patients with excessively raised PCV values. The term idiopathic erythrocytosis should only be used for patients who have been adequately investigated. These patients most commonly present with ischaemic or vascular occlusive symptoms/signs. Relative polycythaemia may be caused by fluid loss, but generally the origin of the low plasma volume is not established. Apparent polycythaemia may represent a physiological variant or a stage before the development of a definitely raised RCM. The management of idiopathic erythrocytosis, and relative and apparent polycythaemia, should initially involved removal of known risk factors if present (e.g. hypertension) with the addition of venesection in selected patients. Reactive thrombocytosis in the elderly is most commonly due to malignant disease of chronic infection. The high platelet count is usually asymptomatic, and antiplatelet therapy is rarely required. Primary thrombocythaemia (PT) is a clonal myeloproliferative disorder similar to PPP. The finding of splenomegaly, abnormal platelet morphology or function helps to separate PT from reactive thrombosis. PT most commonly presents with digital or transient cerebral ischaemia or haemorrhage.(ABSTRACT TRUNCATED AT 400 WORDS)
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