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Dou X, Chen Z, Liu Y, Li Y, Ye J, Lu L. Zebrafish mutants in egln1 display a hypoxic response and develop polycythemia. Life Sci 2024; 344:122564. [PMID: 38492922 DOI: 10.1016/j.lfs.2024.122564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
AIMS Prolyl hydroxylase domain 2 (PHD2), encoded by the Egln1 gene, serves as a pivotal regulator of the hypoxia-inducible factor (HIF) pathway and acts as a cellular oxygen sensor. Somatic inactivation of Phd2 in mice results in polycythemia and congestive heart failure. However, due to the embryonic lethality of Phd2 deficiency, its role in development remains elusive. Here, we investigated the function of two egln1 paralogous genes, egln1a and egln1b, in zebrafish. MAIN METHODS The egln1 null zebrafish were generated using the CRISPR/Cas9 system. Quantitative real-time PCR assays and Western blot analysis were employed to detect the effect of egln1 deficiency on the hypoxia signaling pathway. The hypoxia response of egln1 mutant zebrafish were assessed by analyzing heart rate, gill agitation frequency, and blood flow velocity. Subsequently, o-dianisidine staining and in situ hybridization were used to investigate the role of egln1 in zebrafish hematopoietic function. KEY FINDINGS Our data show that the loss of egln1a or egln1b individually has no visible effects on growth rate. However, the egln1a; egln1b double mutant displayed significant growth retardation and elevated mortality at around 2.5 months old. Both egln1a-null and egln1b-null zebrafish embryo exhibited enhanced tolerance to hypoxia, systemic hypoxic response that include hif pathway activation, increased cardiac activity, and polycythemia. SIGNIFICANCE Our research introduces zebrafish egln1 mutants as the first congenital embryonic viable systemic vertebrate animal model for PHD2, providing novel insights into hypoxic signaling and the progression of PHD2- associated disease.
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Affiliation(s)
- Xuehan Dou
- Laboratory for Marine Drugs and Bioproducts of Laoshan Laboratory, Qingdao, China; Key Laboratory of Marine Drugs, The Ministry of Education of China, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Zhongyuan Chen
- Laboratory for Marine Drugs and Bioproducts of Laoshan Laboratory, Qingdao, China; Key Laboratory of Marine Drugs, The Ministry of Education of China, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Yunzhang Liu
- Laboratory for Marine Drugs and Bioproducts of Laoshan Laboratory, Qingdao, China; Key Laboratory of Marine Drugs, The Ministry of Education of China, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Yun Li
- Laboratory for Marine Drugs and Bioproducts of Laoshan Laboratory, Qingdao, China; Key Laboratory of Marine Drugs, The Ministry of Education of China, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China
| | - Junli Ye
- Department of Physiology and Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, China
| | - Ling Lu
- Laboratory for Marine Drugs and Bioproducts of Laoshan Laboratory, Qingdao, China; Key Laboratory of Marine Drugs, The Ministry of Education of China, School of Medicine and Pharmacy, Ocean University of China, Qingdao, China.
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Ozbasli E, Takmaz O, Unsal G, Kazancı E, Demirelce O, Ozaltin S, Dede FS, Gungor M. Effects of cord clamping timing in at-term elective cesarean section on maternal and neonatal outcomes: a randomized trial. Arch Gynecol Obstet 2024; 309:1883-1891. [PMID: 37162560 DOI: 10.1007/s00404-023-07054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE This study aimed to compare the effects of early cord clamping (ECC), delayed cord clamping (DCC), and umbilical cord milking (MC) on maternal and neonatal outcomes in elective cesarean births. METHODS We analyzed 204 women with uncomplicated at-term singleton pregnancies, who underwent cesarean birth under regional anesthesia between March and July 2021. The women were randomized into three groups: DCC (clamped 60 s postpartum), ECC (clamped within 15 s postpartum), or MC (clamped after milking five times) group. The neonatal and maternal outcomes of the groups were evaluated. RESULTS The duration of the operation was significantly lower (P < 0.001) in the MC group at 50 min (ECC, 60 min; DCC, 60 min), while intraoperative bleeding was significantly higher (P < 0.001) in the ECC group at 500 mL (DCC, 300 mL; MC, 225 mL). The rates of anemia and polycythemia significantly differed (P = 0.049) between the three groups. DCC and MC did not negatively affect maternal and neonatal outcomes compared with ECC. CONCLUSION DCC and MC are superior to ECC in terms of short-term maternal and neonatal outcomes in cases of elective cesarean birth under regional anesthesia.
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Affiliation(s)
- Esra Ozbasli
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey.
| | - Ozguc Takmaz
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
| | - Gozde Unsal
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
| | - Ebru Kazancı
- Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
| | - Ozlem Demirelce
- Department of Biochemistry, Acibadem Mehmet Ali Aydinlar University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
| | - Selin Ozaltin
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
| | - Faruk Suat Dede
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
| | - Mete Gungor
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey
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Mitsuishi A, Nakamura H, Miura Y, Miyata T, Orihashi K, Yoshida K, Araki K. Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report. J Cardiothorac Surg 2024; 19:134. [PMID: 38491494 PMCID: PMC10941378 DOI: 10.1186/s13019-024-02645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on its type (e.g., fusiform or saccular) and diameter. Based on the finite element analysis, peak wall stress has been identified as a more sensitive and specific predictor of rupture in recent years. Moreover, in finite analysis, the neck of aneurysm is the highest peak wall stress and is associated with the rupture point. CASE PRESENTATION A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed. CONCLUSIONS Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. In this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm that is experiencing the highest peak wall stress and is associated with the rupture point. The mural thrombus decreased peak wall stress and could reduce the risk of rupture even for huge saccular aneurysms. Furthermore, the mural thrombus was fully occupied in aneurysms, such as during coil embolization. Thus, polycythemia could decrease the risk of rupture of huge saccular aneurysms.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan.
- Department of Cardiovascular Surgery School of Medicine, Kochi University, 185-1, Kohasu, Nankoku-shi, 783- 8505,, Okohmachi, Kochi Prefecture, Japan.
| | - Hiromasa Nakamura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
| | - Tsuyoshi Miyata
- Liaison Healthcare Engineering Section Medicine, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
| | - Kazumasa Orihashi
- Department of Anesthesiology and intensive Care Medicine, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505, Okohcho, Kochi Prefecture, Japan
| | - Keisuke Yoshida
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
| | - Kouhei Araki
- Department of Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
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Zhu F, Wen R, Tan X, Nie H, Li J, Wang Q, Qin J. Cyanotic Nephropathy in an Adult Patient with Eisenmenger Syndrome: A Case Report and Literature Review. Kidney Blood Press Res 2024; 49:211-217. [PMID: 38447536 DOI: 10.1159/000538100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Cyanotic nephropathy, a rare disease characterized by proteinuria, decreased estimated glomerular filtration rate, thrombocytopenia, polycythemia, and hyperuricemia, may occasionally be secondary to cyanotic congenital heart disease (CHD). There are currently no detailed diagnostic criteria or treatments for cyanotic nephropathy, owing to its extremely low incidence. Eisenmenger syndrome (ES) was initially defined by Paul Wood in pathophysiologic terms as "pulmonary hypertension (PH) at the systemic level, caused by a high pulmonary vascular resistance, with a reversed or bidirectional shunt at the aorto-pulmonary, ventricular, or atrial level." It typically develops in the presence of large, unrepaired atrial or ventricular septal defects, arterial shunts, or complex forms of CHD and is the most severe hemodynamic phenotype of pulmonary arterial hypertension associated with CHD. This study aimed to outline the case of an ES patient who developed cyanotic nephropathy and successfully achieved clinical remission through primary disease treatment and symptomatic management. Overall, this case expands our understanding of cyanotic nephropathy and lays a theoretical reference for the treatment of ES. CASE PRESENTATION A 33-year-old Chinese female attended the outpatient department with abnormal urine test results over the past two and a half years. Following a comprehensive medical history collection, she underwent the necessary tests. Cardiac color ultrasound displayed a significant widening of the pulmonary artery and PH (severe), as well as mild tricuspid regurgitation and patent ductus arteriosus. The results of the kidney biopsy, combined with clinical findings, suggested a high risk of polycythemia-related kidney disease. She was eventually diagnosed with cyanotic nephropathy and ES. Her symptoms were relieved following symptomatic treatment, such as the administration of ambrisentan, febuxostat, and home oxygen therapy. Her follow-up visit at 6 months demonstrated improvements in hyperuricemia and a significant increase in physical strength. CONCLUSION Cyanotic nephropathy is a rare condition in adults. Kidney biopsy remains the gold standard of diagnosis for various nephropathies. Active treatment of CHD and alleviating hypoxia may be pivotal for the treatment of cyanotic nephropathy.
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Affiliation(s)
- Fanyou Zhu
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China,
| | - Rui Wen
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Xiangling Tan
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hongjun Nie
- Department of Ultrasonic Radiology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Jiali Li
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Qi Wang
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Jiao Qin
- Department of Rheumatology and Immunology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Schwarz Y, Klein P, Lev-Shalem L. Masked anemia and hematocrit elevation under sodium glucose transporter inhibitors: findings from a large real-world study. Acta Diabetol 2024; 61:99-105. [PMID: 37698758 DOI: 10.1007/s00592-023-02174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
AIMS Sodium glucose transporter inhibitors (SGLT2i) therapy is associated with an increase in hematocrit as a class effect. There is a lack of information regarding the clinical magnitude and significance of hematocrit elevation, especially cardiovascular outcomes in patients with polycythemia and possible masking of lower hemoglobin levels as a sign of potential severe disease. METHODS A retrospective study utilizing large community healthcare provider electronic database. Hematocrit levels and variables with potential effect on hematocrit change were compared before and during SGLT2i treatment in adults with type 2 diabetes mellitus. RESULTS Study population included 9646 patients treated with Dapagliflozin or Empagliflozin between 01.2015 and 06.2019. Hematocrit levels were significantly higher after treatment initiation (2.1%), with higher median elevation among male vs female (2.3% vs. 1.8%). Anemia prevalence was significantly lower under treatment (20% vs. 31.6%). In multivariable model, gender, smoking status, SGLT2i type, pretreatment hematocrit, diabetes duration, body mass index and estimated glomerular filtration rate change significantly effected hematocrit change. CONCLUSIONS In the current study SGLT2i treatment was associated with significant hematocrit elevation, polycythemia and lower anemia prevalence. Further studies are needed to determine the clinical significance and approach to patients with pretreatment or on treatment polycythemia and the approach to patients with lower-normal hemoglobin levels under SGLT2i treatment.
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Affiliation(s)
- Yair Schwarz
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Derech Sheba 2, 5266202, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
| | - Pinchas Klein
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Derech Sheba 2, 5266202, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
- Maccabi Health Care Services, Tel-Avia-Jaffa, 6812509, Israel
| | - Liat Lev-Shalem
- Maccabi Health Care Services, Tel-Avia-Jaffa, 6812509, Israel
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Omoomi S, Heidarpour M, Rabanipour N, Saadati M, Vakilbashi O, Shafie D. Prevalence of, association with, severity of, and prognostic role of serum hemoglobin level in acutely decompensated heart failure patients. BMC Cardiovasc Disord 2023; 23:491. [PMID: 37794317 PMCID: PMC10552373 DOI: 10.1186/s12872-023-03510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/13/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The role of hemoglobin (Hb) level in the short-term prognosis of patients with acute decompensated heart failure (ADHF) remains a matter of debate. We aimed to declare the prevalence of, association with, severity of, and prognostic role of SHL with ADHF. METHODS Using the data from the Persian Registry Of Cardiovascular Disease/ Heart Failure (PROVE-HF) study, we assessed the association between anemia and polycythemia (Hb < 13 g/dLit, > 16.5 g/dLit in males and < 12 g/dLit, and > 16 g/dLit in females, respectively) and short-term mortality using Cox proportional hazard modeling, with adjustment of clinically relevant variables. RESULTS Of 3652 ADHF patients, anemia was seen in 1673 patients (48.40%). The prevalence of mild, moderate, and severe anemia was 42.33% (n = 1546), 3.23% (n = 118), and 0.24% (n = 9), respectively. Also, 422 patients (11.55%) had polycythemia. Compared to non-anemic patients, anemic patients were mainly male, older, and were more likely to have diabetes mellitus (DM), renal dysfunction, hypertension (HTN), and thyroid disease. Significant predictors of short-term mortality were lower systolic and diastolic blood pressure, lower Hb level, and higher blood urea nitrogen (BUN). Anemic patients had higher all-cause mortality [adjusted hazard ratio (aHR) 1.213, 95% confidence interval [CI] 1.054-1.396]. Moderate anemia increased mortality by approximately 80% in males (aHR 1.793, 95% CI 1.308-2.458) and females (aHR 1.790, 95% CI 1.312-2.442), respectively. Polycythemia had no association with short-term mortality in both genders (P-value > 0.05). CONCLUSIONS This study revealed that anemia is an adverse prognostic factor for short-term mortality in ADHF patients, with higher mortality in moderately anemic patients.
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Affiliation(s)
- Sepehr Omoomi
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Heidarpour
- Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Najmeh Rabanipour
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Science, Isfahan, Iran
| | - Mona Saadati
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Vakilbashi
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Cardiology/Heart Failure and Transplantation, Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Wakabayashi I. Effects of age on polycythemia, cardiometabolic risk and their associations in middle-aged men. J Diabetes Metab Disord 2023; 22:287-295. [PMID: 37255804 PMCID: PMC10225414 DOI: 10.1007/s40200-022-01130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 06/01/2023]
Abstract
Background Polycythemia has been reported to be associated with cardiometabolic risk factors. However, it remains to be determined whether age affects their associations. Methods The subjects were 11,261 men at ages of 30 ~ 65 years who had received annual health checkup examinations. They were divided by age into four groups of 30 ~ 39, 40 ~ 49, 50 ~ 59 and 60 ~ 65 years. Variables related to polycythemia and cardiometabolic risk and their associations were compared in the different age groups. Results The prevalences of polycythemia and metabolic syndrome tended to be lower and higher, respectively, with an increase of age. Odds ratios (ORs) of subjects with vs. subjects without polycythemia for high LDL-C/HDL-C ratio and metabolic syndrome were significantly high in the age group of 30 ~ 39 years when compared with the reference level (OR with 95% confidence interval: 3.21 [2.35 ~ 4.37] [high LDL-C/HDL-C ratio] and 3.49 [2.38 ~ 5.12] [metabolic syndrome]) and tended to be lower with an increase of age (60 ~ 65 years, OR with 95% confidence interval: 1.36 [0.63 ~ 2.93] [high LDL-C/HDL-C ratio] and 1.88 [1.16 ~ 3.03] [metabolic syndrome]). Conclusion The prevalence of polycythemia was higher and its associations with cardiometabolic risk such as high LDL-C/HDL-C ratio and metabolic syndrome were stronger in the youngest group than in the older groups. The results suggest that early detection and correction of polycythemia are more effective than its later correction for prevention of cardiovascular disease in middle-aged men.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, School of Medicine, Hyogo Medical University, Mukogawa-cho 1-1, 663-8501 Nishinomiya, Hyogo Japan
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Duggal N, Singh N, Sachdev S, Singh AK, Hira JK, Chhabra S, Bansal D, Malhotra P, Varma N, Das R, Sharma P. A Screening Approach for Inherited Erythrocytosis due to the VHL:c.598C > T Mutation (Chuvash Polycythemia). Indian J Hematol Blood Transfus 2023:1-5. [PMID: 37362405 PMCID: PMC10183085 DOI: 10.1007/s12288-023-01668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/01/2023] [Indexed: 06/28/2023] Open
Abstract
Genetic work-up of unexplained erythrocytosis that is suspected to be inherited in nature currently requires either laborious exon-by-exon gene panel testing by Sanger sequencing or expensive next-generation sequencing. A high prevalence of Chuvash polycythemia (61%) has been previously reported among north Indian erythrocytosis patients. We assessed PCR-RFLP for VHL c.598C > T mutation as a first-line test in 99 persons with JAK2 V617F-negative, unexplained erythrocytosis. We enrolled two groups: Group A (n = 38) had erythrocytosis patients (n = 33) or their first-degree relatives (n = 5), and, Group B with 61 healthy blood donation volunteers who were deferred after the discovery of unexplained high hemoglobin levels. Detailed history and clinical examination, hemogram, erythropoietin levels and PCR-RFLP for the VHL:c.598C > T;p.R200W mutation were done. In Group A, three (8%) persons aged 9, 13 and 30-years were homozygous for VHL:c.598C > T. Two were heterozygous (parents of a known case of Chuvash polycythemia). None of the Group B subjects had the Chuvash mutation. Erythropoietin levels in group A were low in 5/26 cases (19%) and normal in 18/26 (69%). In Group B, seven (11%) donors had normal values while the remaining 54 (89%) had high erythropoietin levels. Despite a lower frequency (8%) compared to literature, our results suggest that the relatively simpler PCR-RFLP for VHL:c.598C > T mutation may be considered for the initial genetic screening of unexplained, suspected congenital erythrocytosis in regions where Chuvash polycythemia comprises a large proportion of inherited erythrocytosis, after polycythemia vera and common acquired secondary causes are excluded. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01668-9.
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Affiliation(s)
- Nisha Duggal
- Pathology Group of Departments, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Namrata Singh
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Suchet Sachdev
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jasbir Kaur Hira
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Sanjeev Chhabra
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Deepak Bansal
- Pediatric Hematology-Oncology Unit, Department of Pediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Reena Das
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Prashant Sharma
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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Perroud C, Porret N, Rovó A. "The Long Journey of Unexplained Erythrocytosis": Erythrocytosis due to High-Oxygen Affinity Hemoglobinopathy - Hemoglobin Variant Little Rock (HBB: c.432C>A) - A Report of a Swiss Family and Review of the Literature. Acta Haematol 2023; 146:326-330. [PMID: 36940676 DOI: 10.1159/000530240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
The differential diagnosis of erythrocytosis is complex, involving a tailored algorithm. Congenital causes are rare and such patients commonly face a long journey looking for diagnosis. This diagnosis requires expertise and accessibility to modern diagnostic tools. We present the case of a young Swiss man with long-standing erythrocytosis of unknown origin and his family. The patient had an episode of malaise as he went skiing above 2,000 m altitude. In the blood gas analysis, p50 was low (16 mm Hg) and erythropoietin was normal. Using next-generation sequencing, a mutation in the hemoglobin subunit beta gene was found, a pathogenic variant known as hemoglobin Little Rock causing high oxygen affinity. Some family members also had unexplained erythrocytosis, therefore the mutational status of the family was analyzed, the grandmother and mother showed the presence of the same mutation. The use of modern technology finally offered a diagnosis to this family.
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Affiliation(s)
- Camille Perroud
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Naomi Porret
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Hajika Y, Kawaguchi Y, Hamazaki K, Kumeda Y. Polycythemia with elevated erythropoietin production in a patient with a urinary stone and unilateral hydronephrosis: a case report. J Med Case Rep 2023; 17:87. [PMID: 36890599 PMCID: PMC9996984 DOI: 10.1186/s13256-023-03823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/15/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Absolute polycythemia can be primary or secondary. Erythropoietin-producing diseases (for example, hypoxia) are the major cause of secondary polycythemia. There are reports of polycythemia secondary to hydronephrosis. However, to our knowledge, there is no report on polycythemia secondary to hydronephrosis due to a urinary stone. Herein, we present a case of polycythemia with an elevated erythropoietin level in a patient with a urinary stone and unilateral hydronephrosis. CASE PRESENTATION A 57-year-old Japanese man presented with polycythemia and an elevated erythropoietin level. Erythropoietin accumulation was not due to erythropoietin secretion by a tumor as no obvious lesions were detected on contrast-enhanced computed tomography. Abdominal ultrasonography revealed a stone in the left urinary tract and renal hydronephrosis, and 2 weeks later, the patient underwent transurethral ureterolithotripsy without complications. Blood tests 2 weeks after transurethral ureterolithotripsy showed that the erythropoietin level had declined. Hemoglobin concentration decreased from 20.8 mg/dL before and immediately after transurethral ureterolithotripsy to 15.8 mg/dL 3 months after transurethral ureterolithotripsy. This case was diagnosed as erythropoietin elevation due to unilateral hydronephrosis with a urinary stone, resulting in polycythemia. CONCLUSIONS Hydronephrosis is a common disease but is not often associated with polycythemia. Further studies are required to elucidate the mechanism and implications of elevated erythropoietin production in hydronephrosis.
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Affiliation(s)
- Yuriko Hajika
- Department of Internal Medicine, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-Ku, Osaka, 559-0012, Japan.
| | - Yuji Kawaguchi
- Department of Internal Medicine, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-Ku, Osaka, 559-0012, Japan
| | - Kenji Hamazaki
- Department of Internal Medicine, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-Ku, Osaka, 559-0012, Japan
| | - Yasuro Kumeda
- Department of Internal Medicine, Minami Osaka Hospital, 1-18-18 Higashikagaya, Suminoe-Ku, Osaka, 559-0012, Japan
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Singh S, Singh J, Mehta A, Sharma R, Joshi K, Jain K, Paul D, Oberoi G, Jindal N, Dhillon B, Narang V. Distinctive Attributes of Indian Patients With Classical BCR::ABL1 Negative Myeloproliferative Neoplasms: Unified Clinical and Laboratory Data. Clin Lymphoma Myeloma Leuk 2023; 23:360-369.e1. [PMID: 36849307 DOI: 10.1016/j.clml.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION We report one of the largest single center data from a mixed referral setting in India describing baseline characteristics and outcomes of patients with classical BCR::ABL1 negative myeloproliferative neoplasms (MPNs). MATERIALS AND METHODS Patients diagnosed from June 2019 to 2022 were included. Workup and treatment was as per current guidelines. RESULTS Diagnosis comprised polycythemia vera (PV) in 51(49%), ET in 33(31.7%) and prefibrotic primary myelofibrosis (MF) pre fibrotic myelofibrosis (prePMF) and myelofibrosis in 10(9.6%) patients each. Median age at diagnosis was 52 years for PV and ET, 65.5 for MF and 79 years for prePMF. Diagnosis was incidental in 63(56.7%) and after thrombosis in 8(7.2%) patients. Baseline next generation sequencing (NGS) was available for 63(60.5%) patients. Driver mutations in PV: JAK2 in 80.3%; in ET: JAK2 in 41%, CALR in 26%, MPL in 2.9%; in prePMF JAK2 in 70%, CALR in 20%, MPL in 10%, and in MF: JAK2 in 10%, MPL in 30% and CALR in 40%. Seven novel mutations were detected of which 5 were potentially pathogenic on computational analysis. After median follow up of 30 months, 2 patients had disease transformation and none had new episodes of thrombosis. Ten patients died, most commonly with cardiovascular events(n = 5,50%). Median overall survival was not reached. Mean OS time was 10.19 years(95%CI, 8.6 to 11.74) and mean time to transformation was 12.2 years(95% CI,11.8 to 12.6). CONCLUSION Our data indicates comparatively indolent presentation of MPNs in India with younger age and lower risk of thrombosis. Further follow up will enable correlation with molecular data and guide modification of age based risk stratification models.
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Affiliation(s)
- Suvir Singh
- Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, India.
| | - Jagdeep Singh
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Arpan Mehta
- Neuberg Supratech Reference Laboratories, Ahmedabad, India
| | - Rintu Sharma
- Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kaveri Joshi
- Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, India
| | - Kunal Jain
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Davinder Paul
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Gurleen Oberoi
- Department of Hematopathology, All India Institute of Medical Sciences, New Delhi, India
| | - Nandita Jindal
- Department of Molecular Genetics, Dayanand Medical College and Hospital, Ludhiana, India
| | - Barjinderjit Dhillon
- Department of Molecular Genetics, Dayanand Medical College and Hospital, Ludhiana, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, India
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Saxena S, Doyle PW, Baron CM, Doyle TP, Sokolow AG. Rare Cause of Hypoxemia in a Toddler: New Diagnosis of Hereditary Hemorrhagic Telangiectasia. Am J Respir Crit Care Med 2023. [PMID: 36662634 DOI: 10.1164/rccm.202209-1703im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Shikha Saxena
- Vanderbilt University Medical Center, 12328, Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Nashville, Tennessee, United States
| | - Patrick W Doyle
- Vanderbilt University School of Medicine, 12327, Nashville, Tennessee, United States
| | - Christopher M Baron
- Vanderbilt University Medical Center, 12328, Pediatric Interventional Radiology, Department of Diagnostic Imaging, Nashville, Tennessee, United States
| | - Thomas P Doyle
- Vanderbilt University Medical Center, 12328, Division of Pediatric Cardiology, Department of Pediatrics, Nashville, Tennessee, United States
| | - Andrew G Sokolow
- Vanderbilt University Medical Center, 12328, Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Nashville, Tennessee, United States;
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13
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Ernest V, Abbou N, Tichadou A, Arcani R, Venton G. Characteristics of JAK2 unmutated erythrocytosis: Distinctive traits between polycythemia vera and non-polycythemia vera patients. Eur J Intern Med 2023; 107:113-115. [PMID: 36096924 DOI: 10.1016/j.ejim.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Vincent Ernest
- Laboratory of Hemostasis, Assistance Publique-Hôpitaux de Marseille (AP-HM), CHU La Timone, Marseille, France
| | - Norman Abbou
- Biochemistry and Molecular Biology Laboratory, Assistance Publique-Hôpitaux de Marseille (AP-HM), CHU NORD, Marseille, France
| | - Antoine Tichadou
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), CHU La Conception, Marseille, France
| | - Robin Arcani
- Internal Medicine and Therapeutics Department, CHU La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S 1263, Aix-Marseille University, Marseille, France.
| | - Geoffroy Venton
- Hematology and Cellular Therapy Department, Assistance Publique-Hôpitaux de Marseille (AP-HM), CHU La Conception, Marseille, France
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14
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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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Kosińska-Kaczyńska K, Witwicki J, Saletra-Bielińska A, Krajewski P, Krysiak A, Brawura-Biskupski-Samaha R, Walasik I, Zgliczyńska M, Malicka E, Szymusik I. Hemoglobin differences in twins are related to the time of cord clamping, not intertwin transfusion - a prospective cohort study. BMC Pregnancy Childbirth 2022; 22:619. [PMID: 35931974 PMCID: PMC9354348 DOI: 10.1186/s12884-022-04942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Delayed cord clamping increases placental transfusion. In vaginal deliveries higher hemoglobin concentrations are found in the second-born twin. We hypothesized it is unrelated to intertwin transfusion but to the time of cord clamping. Methods: It was a prospective cohort study of 202 women delivering twins > 32 weeks of gestation. Monoamniotic pregnancy, antenatal intertwin transfusions, fetal demise or major abnormalities were excluded from the study. The time of cord clamping depended on the obstetrician’s decision. Hemoglobin, hematocrit, and reticulocyte count were measured at birth and during the second day of life. Results At birth, hemoglobin and hematocrit levels were significantly higher in the first-born twins delivered with delayed than with early cord clamping. Higher hemoglobin and hematocrit levels were observed during the second day of life in all twins delivered with delayed cord clamping. The lowest levels were observed in twins delivered with early cord clamping. Infants delivered with delayed cord clamping were at a lower risk of respiratory disorders and NICU hospitalization. Conclusion The observed differences in Hgb concentrations between the infants in a twin pregnancy are related to cord clamping time.
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Affiliation(s)
- Katarzyna Kosińska-Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, the Center of Postgraduate Medical Education, Ul. Cegłowska 80, 01-809, Warsaw, Poland. .,2Nd Department of Obstetrics and Gynecology of, the Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland.
| | - Jacek Witwicki
- Department of Neonatology of the Center, Postgraduate Medical Education, Ul. Cegłowska 80, 01-809, Warsaw, Poland
| | - Aleksandra Saletra-Bielińska
- 1St Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015, Warsaw, Poland
| | - Paweł Krajewski
- 1St Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015, Warsaw, Poland
| | - Adam Krysiak
- Department of Neonatology of the Center, Postgraduate Medical Education, Ul. Cegłowska 80, 01-809, Warsaw, Poland
| | - Robert Brawura-Biskupski-Samaha
- 2Nd Department of Obstetrics and Gynecology of, the Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland
| | - Izabela Walasik
- Students' Scientific Association at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015, Warsaw, Poland
| | - Magdalena Zgliczyńska
- 2Nd Department of Obstetrics and Gynecology of, the Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland
| | - Ewa Malicka
- 2Nd Department of Obstetrics and Gynecology of, the Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland
| | - Iwona Szymusik
- 1St Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. Starynkiewicza 1/3, 02-015, Warsaw, Poland
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16
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Monzani A, Remorgida V, Rabbone I. High rates of neonatal polycythemia and hyperbilirubinemia during the first phase of COVID-19 pandemic in Italy: a single-center experience. Ital J Pediatr 2022; 48:100. [PMID: 35710390 PMCID: PMC9202325 DOI: 10.1186/s13052-022-01293-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
In our third-level Neonatal Unit in Northern Italy, we recorded a high rate of neonatal hyperbilirubinemia requiring phototherapy in March-November 2020, during the first phase of COVID-19 pandemic, compared to the previous year (198/1348, 14.2%, vs 141/1432, 9.8%, p = 0.0004). Supposing it could be the result of neonatal polycythemia, we evaluated capillary hematocrit (Hct) and the rate of hyperbilirubinemia in all newborns ≥36 weeks gestational age born in December 2020. Out of 73 neonates, 37 had Hct ≥65% (50.7%). However, as capillary blood samples may overestimate Hct by 5-15%, even downsizing all values by 15%, Hct was still ≥65% in 9/73 neonates (12.3%), much higher than 0.4-5% prevalence of polycythemia reported in healthy newborns. All those newborns were singleton and healthy, with no clinical signs of hyperviscosity and no underlying factors predisposing to polycythemia. Out of 73 newborns, 13 (17.8%) developed hyperbilirubinemia requiring phototherapy. Their mean Hct value was 66.3 ± 8.2%. Since hyperbilirubinemia is common in the offspring of women with SARS-CoV-2 infection and we recorded increased rates of neonatal hyperbilirubinemia in the first phase of COVID-19 pandemic, it could be hypothesized that even asymptomatic Sars-CoV2 infection during pregnancy might cause placental vascular malperfusion, eliciting polycythemia in the fetus as a compensatory response, that could be the link between COVID-19 in the mothers and hyperbilirubinemia in the newborns.
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Affiliation(s)
- Alice Monzani
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy.
| | - Valentino Remorgida
- Division of Obstetrics and Gynecology, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, 28100, Novara, Italy
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17
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Wakabayashi I. Associations between polycythemia and cardiometabolic risk factors in middle-aged men. Clin Chim Acta 2022; 531:248-253. [PMID: 35421399 DOI: 10.1016/j.cca.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Polycythemia increases blood viscosity and causes thrombogenesis in cardiovascular disease. However, relationships between polycythemia and cardiometabolic risk factors in a general population remain to be determined. METHODS Subjects were middle-aged Japanese men (n = 11261) receiving annual health checkup examinations. Relationships of polycythemia, defined as hemoglobin concentrations of 16.5 g/dl or higher, with cardiometabolic risk factors, including obesity, hypertension, dyslipidemia and diabetes, were investigated. RESULTS Both in univariable analysis and multivariable analysis with adjustment for age, histories of smoking, alcohol drinking and regular exercise, and medication therapy for hypertension, dyslipidemia or diabetes, waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, LDL cholesterol, cardiometabolic index (CMI) and hemoglobin A1c were significantly higher and HDL cholesterol was significantly lower in the polycythemic group than in the non-polycythemic group. The above associations between polycythemia and cardiovascular risk factors were also found in the sub-analysis for nonsmokers (n = 4937). The odds ratios (ORs) of the polycythemic vs. non-polycythemic groups for high CMI and metabolic syndrome (MS) were significantly high when compared with the reference level in the multivariable analysis (OR with 95% confidence interval: high CMI, 2.18 [1.91∼2.50]; MS, 2.39 [2.02∼2.85]). CONCLUSION Polycythemia showed smoking-independent associations with cardiometabolic risk factors including visceral obesity, hypertension, dyslipidemia, diabetes and metabolic syndrome. Thus, polycythemia is a potential discriminator of cardiovascular risk in the general population.
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Affiliation(s)
- Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
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18
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Hossain ME, Akter N. NaHCO 3, L-arginine, and vitamin C supplemented vegetable diet ameliorates tachycardia and polycythemia in the broiler chicken. Trop Anim Health Prod 2022; 54:122. [PMID: 35233685 DOI: 10.1007/s11250-021-02993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
The study aimed to investigate if vegetable-based high-energy mash diets supplemented with NaHCO3, L-arginine + vitamin C, and vegetable oils were effective against tachycardia and polycythemia in the broiler chicken. A total of 256 Ross-308 day-old male broiler chicks were randomly distributed into eight dietary treatment groups in a three-way ANOVA with 2 × 2 × 2 factorial arrangement (three factors, i.e., NaHCO3, L-arginine + vitamin C, and vegetable oil each with two levels, e.g., 0 and 0.1% of NaHCO3 and L-arginine + vitamin C; 3 and 4% of vegetable oil supplemented with basal diet) for a period of 35 days. Iso-caloric and iso-nitrogenous diets were formulated and supplied ad libitum. The final live weight (FLW), average daily feed intake (ADFI), average daily gain (ADG), feed efficiency (FE), carcass traits, cardio-pulmonary morphometry, total protein (TP), hemoglobin (Hb), triiodothyronine (T3), incidence of tachycardia, and polycythemia were examined. Supplementation of NaHCO3 increased 2.2% ADFI, 5.5% FE, and 23.2% TP. The L-arginine + vitamin C increased 2.4% FLW and decreased 1.9% heart rate. Vegetable oil increased 1.3% ADFI, 4.2% ADG, 8.6% FE, 23.1% Hb, and 15.5% PCV. The NaHCO3, L-arginine + vitamin C, and vegetable oil additively interacted to increase 31.5% T3 at the expense of 21.1% of the weight of the right ventricle (RV). The RV:TV, carcass traits, and hemato-biochemical indices remained within normal range irrespective of the levels of the supplementations of the test ingredients. It was concluded that vegetable-based high-energy mash diets were not susceptible to tachycardia and polycythemia. The addition of NaHCO3 and L-arginine + vitamin C ameliorated the propensity of tachycardia and polycythemia without deteriorating performance, carcass traits, and hemato-biochemical indices of the broiler chicken in a dose-dependent manner.
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Affiliation(s)
- Md Emran Hossain
- Department of Animal Science and Nutrition, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh.
| | - Nasima Akter
- Department of Dairy and Poultry Science, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh
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Vlahakos V, Marathias K, Lionaki S, Loukides S, Zakynthinos S, Vlahakos D. The Paradigm Shift from Polycythemia to Anemia in COPD: The Critical Role of the Renin-Angiotensin System Inhibitors. Expert Rev Respir Med 2022; 16:391-398. [PMID: 35212601 DOI: 10.1080/17476348.2022.2045958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Although polycythemia has been considered a common adverse event in COPD, anemia is reported more often and has gained more importance than polycythemia over the last thirty years. AREAS COVERED Factors considered to be associated with the development of anemia in COPD have included: Aging and kidney dysfunction with erythropoietin deficiency and bone marrow suppression due to uremic toxins; heart failure (HF), which is often encountered in COPD and is accompanied by anemia in one third of the cases; Low-grade chronic inflammation, which can directly suppresses the bone marrow and diminish iron absorption and utilization via increased hepcidin levels; long-term oxygen therapy (LTOT), which ameliorates chronic hypoxia, and most important, RAS inhibitors, which are widely used for the co-morbidities associated with COPD (hypertension, HF, CKD, diabetes) and have previously been shown to lower hematocrit values or cause anemia in various clinical conditions. EXPERT OPINION Introduction of LTOT in COPD and especially the established use of RAS inhibitors form the basis for the shift from polycythemia to anemia in COPD. Interestingly, when the SGLT2 inhibitors are introduced for cardiorenal protection in COPD, one could anticipate correction of anemia or even reemergence of polycythemia, since this new class of drugs can augment erythropoietin secretion and increase hematocrit values.
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Affiliation(s)
- Vassilios Vlahakos
- 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos General Hospital, Athens, Greece
| | - Katerina Marathias
- Department of Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Sofia Lionaki
- 2nd Department of Medicine, Renal Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Spyros Zakynthinos
- 1 Department of Intensive Care Medicine, National and Kapodistrian University of Athens, School of Medicine, Evangelismos General Hospital, Athens, Greece
| | - Demetrios Vlahakos
- 2 Department of Medicine, Renal Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
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Anaqrah H, McCabe DJ. Severe chronic Carboxyhemoglobinemia and polycythemia due to smoking hookah. Am J Emerg Med 2022; 55:226.e1-226.e2. [PMID: 34974952 DOI: 10.1016/j.ajem.2021.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022] Open
Abstract
Acute carbon monoxide (CO) poisoning due to smoking hookah has been reported and may present similarly to other causes of acute carbon monoxide poisoning with nausea, headache, and loss of consciousness [1]. In the acute poisoned patient, immediate removal from the carbon monoxide source is paramount in addition to administration of oxygen and possible hyperbaric oxygen therapy (HBO) in certain situations. However, cases of chronic CO poisoning, treatment options, and long-term adverse health effects are far less reported but may include atherosclerosis and vague neurologic symptoms [2]. We present a case of a patient who chronically smoked hookah creating a condition of chronic carboxyhemoglobinemia which was discovered during work up for unexplained polycythemia. While being seen in the hematology clinic, he was found to have a blood carboxyhemoglobin of level 33.6% despite being asymptomatic. This is the highest recorded hookah-related carboxyhemoglobin concentration in the medical literature; and the significant chronic carboxyhemoglobinemia explained his polycythemia. This case illustrates that a social history is crucial when assessing the patient with severe carboxyhemoglobinemia as HBO is not indicated in chronic CO poisoning in an asymptomatic patient.
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Affiliation(s)
- Hiba Anaqrah
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States of America.
| | - Daniel J McCabe
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States of America; Iowa Poison Control Center, Sioux City, IA, United States of America
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Lee AJ, Kim SG, Nam JY, Yun J, Ryoo HM, Bae SH. Clinical features and outcomes of JAK2 V617F-positive polycythemia vera and essential thrombocythemia according to the JAK2 V617F allele burden. Blood Res 2021; 56:259-265. [PMID: 34801987 PMCID: PMC8721460 DOI: 10.5045/br.2021.2021089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background JAK2 mutation status is a well-known risk factor for thrombosis in patients with myeloproliferative neoplasms. However, the clinical usefulness of JAK2 V617F allele burden is under investigation. Methods We retrospectively evaluated the impact of the JAK2 V617F allele burden on clinical characteristics and outcomes of JAK2 V617F-positive polycythemia vera (PV) and essential thrombocythemia (ET). The JAK2 V617F allele burden was measured using sequencing. Results Altogether, 127 patients with JAK2 V617F mutation (PV, N=61; ET, N=66) were included in this study. JAK2 V617F allele burdens were positively correlated with white blood cell counts, hemoglobin values, lactate dehydrogenase levels, and platelet counts. The median values of JAK2 V617F allele burden in patients with PV and ET were 58% and 30%, respectively. A JAK2 V617F allele burden of ≥30%, older age, and a higher hemoglobin level were risk factors for thrombotic events in ET. In patients with PV, older age was the only thrombotic risk factor. The 8-year probabilities of overall survival (OS) were 82.9% in all patients. A high JAK2 V617F allele burden (≥58%) was associated with poor OS in patients with PV. For the patients with ET, the difference in 8-year OS based on the JAK2 V617F allele burden was not significant. Conclusion The JAK2 V617F allele burden was correlated with hematologic parameters and clinical outcomes. Assessing the JAK2 V617F allele burden can be helpful in predicting the thrombotic risk and disease course in patients with JAK2 V617F-positive PV and ET.
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Affiliation(s)
- A-Jin Lee
- Department of Laboratory Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Sang-Gyung Kim
- Department of Laboratory Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jun Yeb Nam
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jaehum Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hun-Mo Ryoo
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Sung Hwa Bae
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University School of Medicine, Daegu, Korea
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22
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Cohen C, Coulon S, Bhukhai K, Neuraz A, Dussiot M, Fouquet G, Stang MBL, Flamant M, Vrtovsnik F, Hummel A, Knebelmann B, Mesnard L, Rondeau E, Maciel TT, Favale F, Casadevall N, Nguyen-Khoa T, Moutereau S, Legendre C, Benhamou M, Monteiro RC, Hermine O, El Karoui K, Moura IC. Erythrocytosis associated with IgA nephropathy. EBioMedicine 2021; 75:103785. [PMID: 34959131 PMCID: PMC8718985 DOI: 10.1016/j.ebiom.2021.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background Erythrocytosis is a hematological disorder usually related to hematopoietic stem cell somatic mutations. However, unexplained erythrocytosis remains frequent. In this study, we evaluated the involvement of IgA1, a regulator of erythropoiesis also implicated in IgA nephropathy (IgAN) pathophysiology, in unexplained polycythemia/erythrocytosis (PE) of IgAN patients. Methods IgAN-PE patients’ serum was collected, analyzed and used to study IgA1 effect on proliferation and differentiation of erythroid progenitors. Hematological parameters of transgenic mice for human alpha1 heavy chain were studied. Multicentric observational cohorts of chronic kidney disease (CKD) patients, including both native kidney diseases and renal transplants, were studied to analyze patient hemoglobin levels. Findings We retrospectively identified 6 patients with IgAN and unexplained PE. In large CKD cohorts, IgAN was associated with PE in 3.5% of patients (p<0.001 compared to other nephropathies). IgAN was an independent factor associated with higher hemoglobin levels (13.1g/dL vs 12.2 g/dL, p=0.01). During post-transplant anemia, anemia recovery was faster in IgAN patients. Elevated polymeric/monomeric IgA1 ratio as well as high Gd-IgA1 rate were observed in circulating IgA1 of the 6 IgAN-PE patients as compared with control or IgAN patients without PE. IgA1 from these patients increased the sensitivity of erythroid progenitors to Epo. In mice, we also observed an elevation of hematocrit in alpha1 knock-in mice compared to wild type controls. Interpretation These data identify a new etiology of erythrocytosis and demonstrate the role of pIgA1 in human erythropoiesis. This syndrome of IgA-related erythrocytosis should be investigated in case of unexplained erythrocytosis and renal disease. Funding This work was supported by INSERM (French national institute for health and medical research), Labex GRex and Imagine Institute (Paris, France)
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Affiliation(s)
- Camille Cohen
- INSERM U1151 « mechanisms and therapeutic strategies of chronic kidney diseases », Hôpital Necker, Université de Paris, Paris, France; Service de Néphrologie et Transplantation rénale, AP-HP, Hôpital Necker, Paris, France
| | - Séverine Coulon
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France; Service de Pharmacie, Grand Hôpital de l'Est Francilien, Coulommiers, France
| | - Kanit Bhukhai
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France; Present address: Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Antoine Neuraz
- Département d'Informatique Biomédicale, AP-HP, Hôpital Necker, Centre de Recherche des Cordeliers, INSERM UMR 1138 Equipe 22, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Michael Dussiot
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France
| | - Guillemette Fouquet
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France
| | - Marie-Bénédicte Le Stang
- INSERM UMR1149 ; CNRS ERL8252 ; Université de Paris, Laboratoire d'excellence INFLAMEX ; Service d'Immunologie, FHU Apollo, Hôpital Bichat-Claude Bernard, AP-HP; Paris, France
| | - Martin Flamant
- INSERM UMR1149 ; CNRS ERL8252 ; Université de Paris, Laboratoire d'excellence INFLAMEX ; Service d'Immunologie, FHU Apollo, Hôpital Bichat-Claude Bernard, AP-HP; Paris, France; Service de Physiologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - François Vrtovsnik
- INSERM UMR1149 ; CNRS ERL8252 ; Université de Paris, Laboratoire d'excellence INFLAMEX ; Service d'Immunologie, FHU Apollo, Hôpital Bichat-Claude Bernard, AP-HP; Paris, France; Service de Néphrologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Aurélie Hummel
- Service de Néphrologie et Transplantation rénale, AP-HP, Hôpital Necker, Paris, France
| | - Bertrand Knebelmann
- INSERM U1151 « mechanisms and therapeutic strategies of chronic kidney diseases », Hôpital Necker, Université de Paris, Paris, France; Service de Néphrologie et Transplantation rénale, AP-HP, Hôpital Necker, Paris, France
| | - Laurent Mesnard
- Urgences Néphrologiques et Transplantation Rénale, AP-HP, Hôpital Tenon, Paris, France
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, AP-HP, Hôpital Tenon, Paris, France
| | - Thiago T Maciel
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France
| | - Fabrizia Favale
- Service d'hématologie biologique, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Nicole Casadevall
- Service d'hématologie biologique, AP-HP, Hôpital Saint Antoine, Paris, France
| | | | - Stéphane Moutereau
- Service de biochimie, AP-HP, Hôpital Henri Mondor, Paris-Est Université Créteil, France
| | - Christophe Legendre
- INSERM U1151 « mechanisms and therapeutic strategies of chronic kidney diseases », Hôpital Necker, Université de Paris, Paris, France; Service de Néphrologie et Transplantation rénale, AP-HP, Hôpital Necker, Paris, France
| | - Marc Benhamou
- INSERM UMR1149 ; CNRS ERL8252 ; Université de Paris, Laboratoire d'excellence INFLAMEX ; Service d'Immunologie, FHU Apollo, Hôpital Bichat-Claude Bernard, AP-HP; Paris, France
| | - Renato C Monteiro
- INSERM UMR1149 ; CNRS ERL8252 ; Université de Paris, Laboratoire d'excellence INFLAMEX ; Service d'Immunologie, FHU Apollo, Hôpital Bichat-Claude Bernard, AP-HP; Paris, France
| | - Olivier Hermine
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France; Service d'Hématologie clinique, AP-HP, hôpital Necker, Paris, France.
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation rénale, AP-HP, Hôpital Henri Mondor, Institut Mondor de recherche biomédicale (IMRB), Paris-Est Université Créteil, France.
| | - Ivan C Moura
- INSERM UMR1163, CNRS ERL8254, Laboratoire d'excellence GR-Ex, Université René-Descartes, Imagine Institute, Paris, France
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23
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Jagadish S, Howard L, Thati Ganganna S. Atypical presentation of SLC30A10 gene mutation with hypermanganesemia, seizures and polycythemia. Epilepsy Behav Rep 2021; 16:100505. [PMID: 34877518 PMCID: PMC8633869 DOI: 10.1016/j.ebr.2021.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
Seizure was the sole neurological symptom of hereditary hypermanganesemia. In this case. Absence of pyramidal and extrapyramidal signs or liver failure were other outstanding features. Treatment with chelation therapy led to resolution of seizures and T1 hyperintensity on brain MRI.
Manganese is an essential element that is ubiquitously present in our diet and water supply. It is a cofactor for several critical physiological processes. Elevated blood levels of Manganese secondary to SLC30A10 gene mutation presents distinctly with dystonia, polycythemia, chronic liver disease and a characteristic high T1 signal in basal ganglia on brain MRI. The primary treatment for this condition is chelation along with iron therapy. We report a previously healthy boy with compound heterozygous SLC30A10 gene mutations who had a unique clinical presentation with prominent seizures, polycythemia, and characteristic T1 hyperintensity in basal ganglia. Seizures have not been previously reported to be associated with this specific mutation.
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Key Words
- ADHD, attention deficit hyperactivity disorder
- ALT, alanine transaminase
- AST, aspartate transaminase
- CBC, complete blood count
- Dystonia
- EEG, electroencephalogram
- Hypermanganesemia
- MCH, mean corpuscular hemoglobin
- MCHC, mean corpuscular hemoglobin concentration
- MCV, mean corpuscular volume
- MRI, magnetic resonance imaging
- Mn, Manganese
- Polycythemia
- RDW, red cell distribution width
- SLC30A10 gene mutation
- Seizures
- T1 hyperintensity
- TIBC, total iron binding capacity
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24
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Marcus G, Farkouh ME, Minha S, Fuchs S, Kalmanovich E, Beigel R, Iakobishvili Z, Klempfner R, Matezky S, Marcus R. Association of Polycythemia with Outcomes of Acute Coronary Syndrome. Cardiology 2021; 146:720-727. [PMID: 34718235 DOI: 10.1159/000519468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Polycythemia has not been extensively studied for its impact on acute coronary syndrome (ACS) outcomes. A previous study reported only 30-day outcomes to be worse in these patients. METHODS Data from the ACS Israeli survey between 2000 and 2018 were utilized to compare between 3 groups of patients with ACS: anemic group (hemoglobin <12 g/dL for women and <12.5 g/dL for men), normal hemoglobin group, and polycythemic group (>16 g/dL and >16.5 g/dL, respectively). Measured outcomes included 30-day major adverse cardiac events (MACE comprising all-cause mortality, recurrent ACS, need for urgent revascularization, and stroke) and 1- and 5-year all-cause mortality. RESULTS Of 14,746 ACS patients, 10,752 (72.9%) had normal hemoglobin levels, 3,492 (23.7%) were anemic, and 502 (3.4%) were polycythemic. In comparison with normal and anemic patients, polycythemic patients were younger (55.9 ± 10.5 vs. 61.9 ± 12.4 and 71.1 ± 12.2 for anemic, respectively, p < 0.001 for both), more frequently men (93.8% vs. 81.3% and 63.1%, respectively, p < 0.001), and less likely diabetic or hypertensive. Upon adjustment to baseline characteristics, compared with normal hemoglobin, polycythemia was not independently associated with 30-day MACE or 1-year mortality, but it was independently associated with higher risk for 5-year mortality (HR 1.76, 95% CI: 1.19-2.59, p = 0.005). Similar results were observed after propensity score matching. CONCLUSIONS Although younger and with fewer comorbidities, polycythemic ACS patients are at increased risk for long-term all-cause mortality. Further study of this association is warranted to understand the causes and possibly to improve the outcomes of these patients.
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Affiliation(s)
- Gil Marcus
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel.,Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sa'ar Minha
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Shmuel Fuchs
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Eran Kalmanovich
- Department of Cardiology, Shamir Medical Center, Zeriffin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Roy Beigel
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Zaza Iakobishvili
- Department of Community Cardiology, Tel-Aviv District, Clalit Health Services, Tel Aviv-Yafo, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Robert Klempfner
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Shlomo Matezky
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Ronit Marcus
- Department of Hematology, Shamir Medical Center, Zeriffin, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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25
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Yogesh Kumar YS, Sud S, Bhardwaj S, Pareek TK. Acute coronary syndrome in young males after a prolonged stay at high altitude. Med J Armed Forces India 2021; 77:490-493. [PMID: 34594081 DOI: 10.1016/j.mjafi.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022] Open
Abstract
The Indian population is predisposed to acute coronary syndrome at a younger age, but very few cases are reported at high altitude. Acute coronary syndrome is frequently associated with multiple cardiovascular risk factors. During management of seven young patients with acute coronary syndrome, it was found that none of them had conventional cardiovascular risk factors including recent physical exertion. It is a known fact that the risk of vascular thrombosis increases by 30 times in Indian soldiers after a long stay at high altitude. Therefore, it is necessary to carry out the tests for procoagulant markers to know whether the acute coronary syndrome was because of the prothrombotic state, and if yes, was high altitude responsible for the procoagulant state or whether the person per se had a procoagulant syndrome. With the absence of these tests at hospitals at high-altitude areas, it becomes difficult to ascertain the exact cause of acute coronary syndrome. This study highlights the importance of aggressively testing for procoagulant markers in young patients presenting with chest pain at high altitude, even in the absence of traditional risk factors.
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Affiliation(s)
- Y S Yogesh Kumar
- Graded Specialist (Medicine), 403 Field Hospital, C/o 56 APO, India
| | - Saurabh Sud
- Classified Specialist (Anaesthesia & Critical Care), 403 Field Hospital, C/o 56 APO, India
| | - Saurabh Bhardwaj
- Classified Specialist (Aviation Medicine) & Commanding Officer, 403 Field Hospital, C/o 56 APO, India
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26
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Zhang J, DeMeo DL, Silverman EK, Make BJ, Wade RC, Wells JM, Cho MH, Hobbs BD. Secondary polycythemia in chronic obstructive pulmonary disease: prevalence and risk factors. BMC Pulm Med 2021; 21:235. [PMID: 34261472 PMCID: PMC8278596 DOI: 10.1186/s12890-021-01585-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/06/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Secondary polycythemia is associated with cigarette smoking and chronic obstructive pulmonary disease (COPD). However, the prevalence of polycythemia in COPD and the contributing risk factors for polycythemia in COPD have not been extensively studied. METHODS We analyzed the presence of secondary polycythemia in current and former smokers with moderate to very severe COPD at the five-year follow-up visit in the observational COPDGene study. We used logistic regression to evaluate the association of polycythemia with age, sex, race, altitude, current smoking status, spirometry, diffusing capacity for carbon monoxide (DLCO), quantitative chest CT measurements (including emphysema, airway wall thickness, and pulmonary artery to aorta diameter ratio), resting hypoxemia, exercise-induced hypoxemia, and long-term oxygen therapy. RESULTS In a total of 1928 COPDGene participants with moderate to very severe COPD, secondary polycythemia was found in 97 (9.2%) male and 31 (3.5%) female participants. In a multivariable logistic model, severe resting hypoxemia (OR 3.50, 95% CI 1.41-8.66), impaired DLCO (OR 1.28 for each 10-percent decrease in DLCO % predicted, CI 1.09-1.49), male sex (OR 3.60, CI 2.20-5.90), non-Hispanic white race (OR 3.33, CI 1.71-6.50), current smoking (OR 2.55, CI 1.49-4.38), and enrollment in the Denver clinical center (OR 4.42, CI 2.38-8.21) were associated with higher risk for polycythemia. In addition, continuous (OR 0.13, CI 0.05-0.35) and nocturnal (OR 0.46, CI 0.21-0.97) supplemental oxygen were associated with lower risk for polycythemia. Results were similar after excluding participants with anemia and participants enrolled at the Denver clinical center. CONCLUSIONS In a large cohort of individuals with moderate to very severe COPD, male sex, current smoking, enrollment at the Denver clinical center, impaired DLCO, and severe hypoxemia were associated with increased risk for secondary polycythemia. Continuous or nocturnal supplemental oxygen use were associated with decreased risk for polycythemia.
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Affiliation(s)
- Jingzhou Zhang
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry J Make
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - R Chad Wade
- Lung Health Center and the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - J Michael Wells
- Lung Health Center and the Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Birmingham VA Medical Center, Birmingham, AL, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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27
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Fuqua J, Reece J, Sofka S. Successful use of phlebotomy to treat severe secondary polycythemia due to chronic lung disease. Hematol Rep 2021; 13:8961. [PMID: 34221292 PMCID: PMC8215527 DOI: 10.4081/hr.2021.8961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
Secondary polycythemia (SP) occurs as a result of increase erythropoietin levels most commonly as a result of tissue hypoxia. Symptoms such as erythromelalgia, pruritis, and bleeding, which are frequently seen in polycythemia vera (PV), do not commonly occur in SP. Phlebotomy is considered one of the mainstays of therapy for PV but is rarely used for treatment of SP due to concern about worsening tissue hypoxia. We present the case of a patient with severe SP due to chronic hypoxic lung disease who presented with erythromelalgia, pruritis, and bleeding and was treated successfully with therapeutic phlebotomy. This case illustrates the importance of considering the use of therapeutic phlebotomy in symptomatic patients with severe SP.
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Affiliation(s)
- Jacob Fuqua
- Department of Medicine, West Virginia University, Morgantown, WV, USA
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28
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Mahe K, Couturaud F, Kerspern H, Chauveau A, Ianotto JC. Evaluation of beta-2 microglobulin, erythropoietin and tobacco use in polycythemic cases. Int J Hematol 2021; 114:222-227. [PMID: 34021850 DOI: 10.1007/s12185-021-03164-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 01/04/2023]
Abstract
In the 2016 WHO classification, hemoglobin and hematocrit thresholds for diagnosing polycythemia vera (PV) have been lowered, increasing the number of consultations for polycythemia investigations. In PV, beta-2 microglobulin (B2m) levels are reportedly increased, whereas erythropoietin (EPO) levels are usually low. Most secondary polycythemia cases (SP) are caused by tobacco use. We decided to analyze the relevance of these three parameters in all patients seen for polycythemia investigations to help differentiate PV from SP cases. A cohort of 257 patients (123 PV; 134 SP) was identified. The median B2m level was higher for PV patients (3.16 vs 1.98 mg/l, p < 0.0001). Increased B2m levels were observed in 83.7% of PV patients (11.9% in SP). The median EPO level was lower in PV patients (4.4 vs 12.3 UI/l, p < 0.0001). Tobacco was used by 42.8% of SP patients (8% in PV, p < 0.0001). Increased B2m, low EPO and no tobacco exposure was predictive of PV (specificity and positive predictive value = 100%). Normal B2m, normal EPO and tobacco exposure was predictive of SP (positive predictive value = 100%). These simple and inexpensive parameters could be used to rapidly differentiate PV from SP cases, before prescribing time-consuming JAK2 V617F mutation analysis by specialists.
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Affiliation(s)
- Kristell Mahe
- Hématologie Clinique, CH Cornouaille, Quimper, France
| | - Francis Couturaud
- Département de Médecine Interne Et de Pneumologie, CHRU de Brest, Brest, France.,EA3878 GETBO, Groupe D'Etude de La Thrombose en Bretagne Occidentale, Brest, France
| | | | - Aurélie Chauveau
- Laboratoire D'Hématologie, CHRU de Brest, Brest, France.,FIM, France Intergroupe Des Syndromes Myéloprolifératifs, Paris, France
| | - Jean-Christophe Ianotto
- EA3878 GETBO, Groupe D'Etude de La Thrombose en Bretagne Occidentale, Brest, France. .,FIM, France Intergroupe Des Syndromes Myéloprolifératifs, Paris, France. .,Hématologie Clinique, Institut de Cancéro-Hématologie, CHRU de Brest, Brest, France.
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29
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Davila-Gonzalez D, Barrios-Ruiz A, Fountain E, Cheng L, Masarova L, Verstovsek S, Rojas-Hernandez CM. Diagnostic Performance of Erythropoietin Levels in Polycythemia Vera: Experience at a Comprehensive Cancer Center. Clin Lymphoma Myeloma Leuk 2021; 21:224-229. [PMID: 33349602 DOI: 10.1016/j.clml.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Considering the evolving diagnostic criteria of polycythemia vera (PV), we analyzed the utility of serum erythropoietin (EPO) as a predictive marker for differentiating polycythemia vera (PV) from other etiologies of erythrocytosis. PATIENTS AND METHODS We conducted a retrospective study after a review of electronical medical records from January 2005 to December 2016 with diagnosis of erythrocytosis using International Classification of Disease-specific codes. To evaluate the diagnostic performance of EPO levels and JAK2-V617F mutation, we constructed a receiver-operated characteristic curve of sensitivity versus 1-specificity for serum EPO levels and JAK2-V617F mutation as predictive markers for differentiating PV from other causes of erythrocytosis. RESULTS We surveyed 577 patients with erythrocytosis. Median patient age was 59.2 years, 57.72% (n = 329) were male, 86.3% (n = 491) were white, and only 3.3% (n = 19) were African American. A total of 80.88% (n = 351) of those diagnosed with PV had a JAK2-V617F mutation compared to only 1.47% (n = 2) whose primary diagnosis was secondary polycythemia. When comparing JAK2-V617 mutation to the EPO level, the area under the curve of JAK2-V617 (0.8970) was statistically larger than that of EPO test (0.6765). Therefore, the PV diagnostic methodology using JAK2-V617 is better than the EPO test. An EPO level of < 2 mIU/mL was > 99% specific to predict PV but was only 12% sensitive. CONCLUSION In the appropriate clinical setting, cytogenetic and molecular studies such as JAK2 mutation status prevail as the most useful tools for PV case identification. The use of isolated EPO to screen patients with erythrocytosis is not a good diagnostic approach.
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Affiliation(s)
- Daniel Davila-Gonzalez
- School of Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Alanna Barrios-Ruiz
- School of Medicine, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Eric Fountain
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lee Cheng
- Institute of Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lucia Masarova
- Division of Cancer Medicine, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Srdan Verstovsek
- Division of Cancer Medicine, Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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El-Ghonemy MS, El-Ashwah S, Denewer M, Soliman EA, El-Baiomy M, Elkerdawy H, El-Sebaie A. Predictive Value of Kozak Gene Polymorphism for Thrombosis in Patients with Philadelphia-Negative MPNs. Asian Pac J Cancer Prev 2021; 22:1195-1201. [PMID: 33906312 PMCID: PMC8325125 DOI: 10.31557/apjcp.2021.22.4.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Philadelphia-negative myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET) and myelofibrosis are clonal haematopoietic stem cell disorders characterized by dysregulated proliferation. The arterial and venous thromboses are the major causes of morbidity and mortality in MPNs. The platelet GP Ib-IX-V receptor complex plays an important role in thrombus formation as the Kozak sequence polymorphism of platelet GP Ibα is associated with increased receptor density. Materials and Methods: This study was conducted on 286 diagnosed patients with Ph-negative MPNs (94 patients of PV, 102 of ET and 90 of MF). In addition, 107 apparently healthy individuals served as a control group. Results: This study revealed that by taking rs2243093 TT as the reference genotype and T as the reference allele; TC, CC, TC+CC genotypes showed lower frequency in ET patients (p= 0.005, 0.007 and 0.001 respectively) and MF patients (p= 0.002, 0.047 and 0.001 respectively) when compared to control groups also, C allele in both groups compared to control (p ≤ 0.001 both). CC genotypes and C allele showed lower frequency in PV patients when compared to control groups (p= 0.032 and 0.026 respectively). Conclusion: From this study we could conclude that patients with Philadelphia-negative MPNs carried Kozak gene polymorphism significantly TT genotype in all patients PV, ET, MF patients and TC in ET and MF patients. The platelet glycoprotein Ibα (Kozak) gene could be incorporated into the routine workup to predict venous thrombosis in patients with Ph-negative MPNs specially ET patients.
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Affiliation(s)
- Mohammed Sabry El-Ghonemy
- Hematology Unit, Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Shaimaa El-Ashwah
- Clinical Hematology Unit, Oncology Center Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - May Denewer
- Clinical Hematology Unit, Oncology Center Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Eman Adel Soliman
- Specialist at Molecular Biology Lab., Oncology Center Mansoura University, Mansoura, Egypt
| | - Mohammed El-Baiomy
- Medical Oncology Unit, Oncology Center Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Heidi Elkerdawy
- Clinical Hematology Unit, Internal Medicine department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Ahmed El-Sebaie
- Hematology Unit, Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Singh S, Kaur K, Paul D, Jain K, Singh J, Narang V, Garg B, Sood N, Dhillon B. Clinical and Molecular Attributes of Patients With BCR/ABL1-negative Myeloproliferative Neoplasms in India: Real-world Data and Challenges. Clin Lymphoma Myeloma Leuk 2021; 21:e569-e578. [PMID: 33757770 DOI: 10.1016/j.clml.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Classic BCR/ABL1-negative myeloproliferative neoplasms (MPNs) are characterized by clinical and genetic heterogeneity and include 4 distinct constituents. Very little data on clinical presentation and epidemiology of the same is available from the Indian setting. PATIENTS AND METHODS Patients referred to Hematology-Oncology from January 2018 to August 2020 with suspected MPNs were included in the analysis and prospectively followed-up. All patients were initially screened, and only those meeting the updated World Health Organization 2016 criteria were included in the analysis. Epidemiologic, clinical, and molecular characteristics were documented, and patients were followed-up prospectively. RESULTS A total of 233 patients were referred for evaluation of MPN, of which 63 were included in the analysis, including 39 males and 24 females. The median age at diagnosis was 57 years (range, 28-82 years), and 38% patients were younger than 50 years of age. The most common presentations were incidental detection in 35 (55.5%), abdominal symptoms in 13 (20%), fatiguability in 7 (11%), and recent vascular events in 6 (9.5%) patients. Final diagnosis was polycythemia vera in 27, essential thrombocytosis (ET) in 21, prefibrotic myelofibrosis in 9, and myelofibrosis in 6 patients. The frequency of driver mutations in polycythemia vera included JAK2 in 75%; in ET, JAK2 in 33%, CALR in 33%, and MPL in 4%; and in prefibrotic myelofibrosis, JAK2 in 66% and CALR in 33%. Aspirin was used for all patients along with risk-adapted cytoreduction with hydroxyurea. Ruxolitinib was reserved for symptoms refractory to hydroxyurea. After a median follow-up of 15 months (interquartile range, 10-28 months) from diagnosis, disease progression was noted in 4 patients. Two patients died at the end of the follow-up period, including 1 with secondary acute myeloid leukemia post myelofibrosis and one with ET and coexistent oral malignancy. The remaining 61 patients are alive and on regular treatment. RESULTS This is one of the first systematic descriptions and prospective follow-up of patients with BCR/ABL-negative MPNs from India. Our study indicates a younger median age of presentation and higher proportion of JAK2-unmutated disease across all subtypes. The primary role of bone marrow morphology and supportive role of somatic mutations in differentiating MPN subtypes is indicated. CONCLUSIONS This study sets the stage for a collaborative registry for defining epidemiologic data and long-term outcomes with MPN in India.
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Affiliation(s)
- Suvir Singh
- Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
| | - Komalpreet Kaur
- Department of Clinical Haematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Davinder Paul
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kunal Jain
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Jagdeep Singh
- Department of Medical Oncology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bhavna Garg
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Barjinderjit Dhillon
- Molecular Genetics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Kim IS, Lee BK, Yang PS, Joung B, Kim JY. Sex-based Approach for the Clinical Impact of the Increased Hemoglobin on Incident AF in the General Population. Korean Circ J 2020; 50:1095-1110. [PMID: 33258318 PMCID: PMC7707984 DOI: 10.4070/kcj.2020.0412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/12/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives Although the adverse cardiovascular effect of anemia has been well described, the effect of polycythemia on the incident atrial fibrillation (AF) remain unclear. The objective of this study is to identify the association between increased hemoglobin and incident AF. Methods This was a retrospective-cohort study with 434,269 subjects who underwent national health examinations from the Korean National Sample Cohort. We estimated the risk of incident AF according to hemoglobin-based four-categories. Results During 3.9-year of follow-up, polycythemia group showed higher incidences of AF (hazard ratio[HR] with 95% confidence interval[CI], 1.50 [1.28–1.76] and 1.69 [1.13–2.56]; in men and women, respectively) than normal hemoglobin group (each p<0.001). In the normal hemoglobin and polycythemia groups, a 1 g/dL increase in hemoglobin level was associated with increased risks of incident AF (1.12 [1.07–1.17] and 1.18 [1.10–1.26] in men and women, each p<0.001). To investigate the specific hemoglobin concentration related to greater AF incidence, we analyzed the sensitivity/specificity of different hemoglobin levels: ≥16.0 g/dL in men and ≥14.5 g/dL in women showed the highest Youden's index, with c-indices of 0.83 and 0.82, respectively. Kaplan-Meier cumulative-event curves according to these specific hemoglobin levels (≥16.0 g/dL in men and ≥14.5 g/dL in women) also showed consistent results in both sexes (each p<0.05). Conclusions Even in the Korean general population, increased hemoglobin was significantly associated with higher rate of incident AF. Especially, subjects with hemoglobin levels ≥14.5 g/dL in women and ≥16.0 g/dL among men were associated with increased risk of incident AF.
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Affiliation(s)
- In Soo Kim
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Youn Kim
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Sánchez K, Ballaz SJ. Might a high hemoglobin mass be involved in non-cardiogenic pulmonary edema? The case of the chronic maladaptation to high-altitude in the Andes. Med Hypotheses 2020; 146:110418. [PMID: 33268002 DOI: 10.1016/j.mehy.2020.110418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
Exposure to hypoxic environments when ascending at high altitudes may cause life-threatening pulmonary edema (HAPE) due to a rapid accumulation of extracellular fluid flooding in the pulmonary alveoli. In Andeans, high-altitude adaptation occurs at the expense of being more prone to chronic mountain sickness: relative hypoventilation, excess pulmonary hypertension, and secondary polycythemia. Because HAPE prevalence is high in the Andes, we posit the hypothesis that a high hemoglobine mass may increase HAPE risk. In support of it, high intrapulmonary hypertension along with hyperviscosity produced by polycytemia may enhance sear forces and intravascular hemolysis, thus leading to increased acellular hemoglobin and the subsequent damage of the alveolar and endothelial barrier. It is proposed to investigate the relationship between the vaso-endothelial homeostasis and erythropoiesis in the maladaptation to high altitude and HAPE. This research is especially important when reentry HAPE, since rheologic properties of blood changes with rapid ascent to high altitudes.
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Affiliation(s)
- Karen Sánchez
- School of Biological Sciences & Engineering. Yachay Tech University, San Miguel de Urcuquí, Ecuador
| | - Santiago J Ballaz
- School of Biological Sciences & Engineering. Yachay Tech University, San Miguel de Urcuquí, Ecuador.
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Yarci E, Tayman C, Cakir U, Serkant U. Serum Endocan, Neuron-Specific Enolase and Ischemia-Modified Albumin Levels in Newborns with Partial Blood Exchange Transfusion. Comb Chem High Throughput Screen 2020; 24:825-830. [PMID: 33109054 DOI: 10.2174/1386207323999200820163525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hyperviscosity of blood secondary to polycythemia results in increased resistance to blood flow and decrease in delivery of oxygen. OBJECTIVE To evaluate whether serum endocan, NSE and IMA levels can be compared in terms of endothelial injury/ dysfunction and neuronal damage in term neonates with polycythemia who underwent PET. METHODS 38 symptomatic polycythemic newborns having PET and 38 healthy newborns were included in the study. Blood samples for endocan, NSE and IMA were taken at only postnatal 24 hours of age in the control group and in polycytemia group just before PET, at 24 and 72 hours after PET. RESULTS The polycythemia group had higher serum endocan(1073,4 ± 644,8 vs. 378,8 ± 95,9ng/ml; p<0.05), IMA(1,32 ± 0,34 vs.0,601 ± 0,095absorbance unit; p<0.05) and NSE(44,7 ± 4,3 vs. 26,91 ± 7,12μg/l; p<0.05) levels than control group before the PET procedure. At 24 hours after PET, IMA(0,656 ± 0,07 vs. 0,601 ± 0,095absorbance unit; p<0.05) and endocan(510,9 ± 228,6 vs. 378,8 ± 95,9ng/ml; p<0.05) levels were closer to the control group, being still statistically significant higher. NSE levels decreased to control group levels having no difference between the PET and control groups at 24 hours after PET (28,98 ± 6,5 vs. 26,91 ± 7,12μg/l; p>0.05). At 72 hours after PET the polycythemia and control groups did not differ statistically for IMA, endocan and NSE levels (p>0.05). CONCLUSION Serum endocan and IMA levels can be used as a biomarker for endothelial damage/ dysfunction and tissue hypoxia in infants with symptomatic polycytemia.
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Affiliation(s)
- Erbu Yarci
- Departmant of Neonatology, University of Health Sciences, Zekai Tahir Burak Womens' Health Training and Research Hospital, Ankara, Turkey
| | - Cuneyt Tayman
- Departmant of Neonatology, University of Health Sciences, Zekai Tahir Burak Womens' Health Training and Research Hospital, Ankara, Turkey
| | - Ufuk Cakir
- Departmant of Neonatology, University of Health Sciences, Zekai Tahir Burak Womens' Health Training and Research Hospital, Ankara, Turkey
| | - Utku Serkant
- Department of Biochemistry, Golbası Public Hospital, Ankara, Turkey
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Teng P, Li W, Ni Y. Surgical lobectomy of pulmonary arteriovenous malformations in a patient with presentations regarded as sequela of tuberculosis: a case report. J Cardiothorac Surg 2020; 15:290. [PMID: 33008483 PMCID: PMC7530952 DOI: 10.1186/s13019-020-01319-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Pulmonary arteriovenous malformations are uncommon conditions of abnormal communications between pulmonary arteries and veins, which are most commonly congenital in nature. Although such condition is not extremely rare, it is a challenge to the differential diagnosis of pulmonary problems such as hypoxemia and pulmonary lesions. Case presentation We report a meaningful case of a 23-year-old male presented with elevated hemoglobin (23.0 g/dl) on admission. Physical examination revealed cyanosis, digital clubbing and low oxygen saturation on room air. The patient was initially diagnosed as polycythemia vera while the subsequent result of bone marrow aspiration was negative. During further assessment, pulmonary arteriovenous malformations were detected by CT pulmonary angiography. Lobectomy was successfully performed with significant increase in oxygen saturation from 86 to 98%. The hemoglobin decreased to almost normal level of 14.9 g/dl 3 months after surgery and the patient had been followed up for nearly 5 years. Conclusions Pulmonary arteriovenous malformations should be suspected in patients with central cyanosis, digital clubbing, polycythemia, pulmonary lesion and without cardiac malformations. Embolization or surgery is strongly recommended to reduce the risks caused by pulmonary arteriovenous malformations.
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Affiliation(s)
- Peng Teng
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China
| | - Weidong Li
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79#, Qingchun Road, Hangzhou, 310000, Zhejiang, China.
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Mahmud R, Ariffin F, Shanmuganathan P. Polycythaemia Vera JAK 2 Mutation in a Patient with Underlying Chronic Obstructive Pulmonary Disease at a Primary Care Setting. Korean J Fam Med 2020; 41:263-266. [PMID: 32512984 PMCID: PMC7385292 DOI: 10.4082/kjfm.18.0161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/23/2018] [Indexed: 11/24/2022] Open
Abstract
The presence of erythrocytosis along with the diagnosis of chronic obstructive pulmonary disease (COPD) may veer a primary care clinician in a busy clinic towards attributing the erythrocytosis to hypoxia secondary to COPD; however, this is not always the case. This case highlights the importance of investigation and the significance not excluding a primary cause in COPD patients with erythrocytosis. A 57-year-old male, presenting with chronic cough, was subsequently diagnosed with COPD clinically and confirmed by spirometry. Erythrocytosis was also incidentally noted. The patient did not have any symptoms of polycythemia or hepatosplenomegaly. Therefore, the erythrocytosis was initially thought to be caused by hypoxia secondary to COPD. However, the JAK2 V617F gene mutation was detected and hence the diagnosis of polycythemia vera was made. Although the erythrocytosis was initially attributed secondary to the underlying pulmonary disease, investigations proved it to be primary in origin. This case report highlights the importance of investigating the underlying cause and to confirm the diagnosis of erythrocytosis as primary and secondary polycythemia differ in their management approach. This will avoid inappropriate diagnosis, treatment, and undesirable outcomes.
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Affiliation(s)
- Rafidah Mahmud
- Department of Primary Care Medicine, Faculty of Medicine, University Teknologi MARA (UiTM), Batu Caves, Malaysia
| | - Farnaza Ariffin
- Department of Primary Care Medicine, Faculty of Medicine, University Teknologi MARA (UiTM), Batu Caves, Malaysia
| | - Punithavathy Shanmuganathan
- Department of Primary Care Medicine, Faculty of Medicine, University Teknologi MARA (UiTM), Batu Caves, Malaysia
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Abstract
OBJECTIVES To evaluate therapeutic phlebotomy (TP) requests for testosterone replacement therapy (TRT) and to highlight the impact to a blood center (BC) or service that provides TP for individuals on TRT. METHODS Review of TP requests for individuals on TRT at our BC over a 3-year period from 2014 through 2016, as well as the total number of TP collections. RESULTS Total TPs during 2014, 2015, and 2016 were 475, 500, and 569, respectively. Annual TP collections for patients on TRT were 193, 212, and 239, respectively. TRT patients with TP orders increased 71.4% during this period. After discontinuation of TP services for TRT at our BC, 32% continued to donate as volunteer blood donors at our BC. CONCLUSIONS Our BC observed increased TP requests for patients on TRT from 2014 through 2016. Our findings suggest that individuals on TRT may be presenting to BCs as volunteer blood donors to avoid charges for TP.
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Affiliation(s)
| | - Anita J Hove
- Physician Services, Division of New York Blood Center, St Paul, MN
| | - Tracy A French
- Collections Quality, Memorial Blood Centers, Innovative Blood Resources, Division of New York Blood Center, St Paul, MN
| | - Jed B Gorlin
- Physician Services, Division of New York Blood Center, St Paul, MN
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Han I, Cho YW, Park SE, An MG, Kang HJ, Lee AR. Acute normovolemic hemodilution for a patient with secondary polycythemia undergoing aortic valve replacement due to severe aortic stenosis - A case report. Anesth Pain Med (Seoul) 2020; 15:181-186. [PMID: 33329811 PMCID: PMC7713815 DOI: 10.17085/apm.2020.15.2.181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/29/2019] [Accepted: 09/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background A high hematocrit level in patients with erythrocytosis is linked with increased blood viscosity and increased risk of thromboembolism. Therefore, it is necessary to adequately lower the hematocrit level before performing a high-risk surgery. Case A 67-year-old male was scheduled for aortic valve replacement due to severe aortic stenosis. The preoperative hematocrit level of this patient was very high due to secondary polycythemia by hypoxia. We decided to perform acute normovolemic hemodilution after anesthetic induction to reduce the risk of thromboembolism in the patient. The patient was discharged after a successful surgery and a post-operative period without any side effects.
Conclusions We estimate that patients with secondary polycythemia may benefit from acute normovolemic hemodilution to reduce their hematocrit levels while undergoing cardiac surgery using cardiopulmonary bypass. However, it is necessary to control the hematocrit level, since a significant decrease can cause side effects.
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Affiliation(s)
- Ilsang Han
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Woo Cho
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Min Gi An
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Ho June Kang
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - A-Ran Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
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Lundy SD, Parekh NV, Shoskes DA. Obstructive Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy. J Sex Med 2020; 17:1297-1303. [PMID: 32307242 DOI: 10.1016/j.jsxm.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Polycythemia (erythrocytosis) is a known side effect of testosterone (T) replacement therapy (TRT) and appears to correlate with maximum T levels. There is also a well-established association between obstructive sleep apnea (OSA) and the development of polycythemia, which confers additional long-term cardiovascular morbidity. Synergy between TRT and OSA in the development of polycythemia remains poorly understood. AIM The objective of this study was to retrospectively assess the relationship of OSA and secondary polycythemia in hypogonadal men receiving TRT. METHODS We performed a retrospective chart review of all men treated by a single provider from 2015 to 2019 for the diagnosis of hypogonadism. Patients who developed a hematocrit of 52% or greater were classified as having polycythemia. OSA was identified via clinical documentation or use of nocturnal continuous positive airway pressure. Demographics, laboratory values, treatment details, and comorbidities were recorded. Data were reported as mean ± SD for parametric variables and median [interquartile range] for non-parametric values. OUTCOME The primary outcome of this study was the association between OSA and polycythemia in hypogonadal men on TRT. RESULTS 474 men were included in this study. 62/474 (13.1%) men met the criteria for the diagnosis of polycythemia with a median hematocrit of 53.6 [interquartile range 52.6, 55.5]. Univariate analysis demonstrated a strong positive association between polycythemia and the concomitant diagnosis of OSA in hypogonadal men (P = .002). Even after correcting for age, body mass index (BMI), and peak T levels in the multivariate analysis (P = .01), this relationship remained significant with an odds ratio of 2.09 [95% CI 1.17, 3.76]. 37 men on TRT with polycythemia and OSA were included in the final cohort with a mean age of 59.2 ± 11.4 years, mean BMI of 32.4 ± 6.0, and median time from TRT initiation to polycythemia diagnosis of 3 years. All patients diagnosed with OSA were prescribed continuous positive airway pressure with poor compliance noted in 52.8% of men. 37.8% were managed via phlebotomy and 59.5% were managed via dose de-escalation of TRT. In hypogonadal men on TRT with polycythemia, BMI was the only risk factor strongly associated with OSA (P = .013). CLINICAL TRANSLATION In hypogonadal men (particularly those with elevated BMI) on TRT who develop secondary polycythemia, a diagnosis of OSA should be strongly considered. STRENGTHS & LIMITATIONS This is a single provider retrospective study and further studies are needed to assess generalizability. CONCLUSIONS In this retrospective single-center cohort, the development of polycythemia in hypogonadal men on TRT was associated with an increased prevalence of OSA. Lundy SD, Parekh NV, Shoskes DA. Obstructive Sleep Apnea Is Associated With Polycythemia in Hypogonadal Men on Testosterone Replacement Therapy. J Sex Med 2020;17:1297-1303.
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Affiliation(s)
- Scott D Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Neel V Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel A Shoskes
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Khurana H, Lakshman P, Kumar K, Jain A. Dissecting Primary Erythrocytosis Among Polycythemia Patients Referred to an Indian Armed Forces Hospital. Indian J Hematol Blood Transfus 2020; 36:187-191. [PMID: 32158103 DOI: 10.1007/s12288-019-01155-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
Referrals for evaluation of polycythemia cases have increased since the hemoglobin (Hb) thresholds for diagnosis of Polycythemia Vera (PV) have been lowered by WHO. The current study enrolled patients of age > 18 years from the Indian Armed Forces or their family members with polycythemia from November 2016 to October 2018. After exclusion of secondary causes, 49 patients were diagnosed as Primary Erythrocytosis (PE). The patients were classified into two groups: PV and Idiopathic Erythrocytosis (IE) and a systematic comparison of clinical and laboratory features of the two groups was done. The prevalence of PV in PE was 20.4% (10 of 49) while the rest 39 (79.6%) had IE. Seven PV patients had JAK2 V617F mutation, one had JAK2 Exon12 mutation, and two were JAK2 negative PV. Nine of 10 (90%) PV patients had Hb > 18.5 g/dl, while only 21 of 39 (53.8%) IE patients had Hb > 18.5 g/dl (p = 0.06). None of the JAK2 mutated patients had Hb < 18.5 g/dl. We conclude that PV is more prevalent in patients of PE with Hb > 18.5 g/dl. Most patients with Hb between 16.5-18.5 g/dl would still be classified as IE. We advocate the need for further studies evaluating the utility of investigating all patients of PE with the revised WHO Hb threshold as well as studies on genetic profile of IE patients from India.
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Affiliation(s)
- Harshit Khurana
- 1Medical Division, Command Hospital Air Force (CHAF), Bangalore, Karnataka India
| | - Praveen Lakshman
- 1Medical Division, Command Hospital Air Force (CHAF), Bangalore, Karnataka India
| | - Kishore Kumar
- 1Medical Division, Command Hospital Air Force (CHAF), Bangalore, Karnataka India
| | - Arihant Jain
- 2Department of Internal Medicine (Clinical Hematology Division), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Alkhedaide AQ. Tobacco smoking causes secondary polycythemia and a mild leukocytosis among heavy smokers in Taif City in Saudi Arabia. Saudi J Biol Sci 2020; 27:407-411. [PMID: 31889864 PMCID: PMC6933161 DOI: 10.1016/j.sjbs.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022] Open
Abstract
Tobacco smoking is a common risk factor of cardiovascular diseases, cancers and heart health problems. In Taif, the number of secondary polycythemia patients is increasing dramatically and most of those patients are heavy smokers. Therefore, this study is an attempt to understand the pathophysiological mechanism behind that problem. Whole blood and serum samples were collected from forty healthy people and forty tobacco smokers, voluntary for this study. Complete blood counts revealed a significant increase in the red blood cell count, hemoglobin concentrations, hematocrit and neutrophils with some elevations in total white blood cells, lymphocytes and monocytes. Moreover, serum analysis of both erythropoietin and interleukin-7 showed a significant reduction in their levels among smokers which were about 35% and 65% respectively. Gene expression study showed a significant upregulation of RAG-1, RAG-2 and EPOR-1 genes caused by tobacco smoking. In conclusion, data presented in the current study suggest that tobacco smoking might cause alveolar tissue inflammation and vascular injury causing an immune response that elevates the white blood cells count. Another suggestion is that tobacco smoking defects the pulmonary gaseous exchange mechanism leading to the secondary polycythemia indicated by the increase in red blood cell count, hemoglobin levels, hematocrit and by the low serum erythropoietin levels.
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Affiliation(s)
- Adel Qlayel Alkhedaide
- Laboratory Technology Department, Turabah University College, Taif University, 5137, Unit No. 1, At Taif 26522 - 7360, Saudi Arabia
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AlQahtany FS, Algahtani FH, Alshebly MM, Madkhaly FM, Ghandour MK, Almalki JH, AlOtaibi WS, Salim A, Mendoza FC. Association between cigarette & shisha smoking and the severity of polycythemia: A cross sectional study. Saudi J Biol Sci 2019; 27:460-464. [PMID: 31889871 PMCID: PMC6933157 DOI: 10.1016/j.sjbs.2019.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/20/2022] Open
Abstract
Tobacco cigarette smoking is assumed to be a key reason of death all over the world. Smoking had both severe as well long-lasting effects on hematological constraints. As per the data available from World Health Organization, every year nearly 5 million individuals die around the world due to the diseases triggered by smoking. Cigarette smoking is linked with an elevated risk of cardiovascular diseases. To examine the association between shisha or cigarette smoking and the severity of polycythemia, present study is a cross-sectional organized at King Saud University Medical City during the period from October 2017 to April 2018. Participants were patients who have hemoglobin level above 160 g/L on multiple reading in KSUMC between May 2015-February 2018. The sample size (227 patients) was computed on single proportion formula, Data were collected through questionnaires and from medical record of the patients. A pilot study was conducted to evaluate the validity of the questionnaire. A statistical analysis was performed using SPSS 21.0 version. A p-value of ≤ 0.05 considered as statistically significant. Out of 227 study subjects, 86 (37.8%) were smokers, (61.6%) were cigarette smokers while (29%), shisha smokers. Total (9.3%) were smoking both cigarette and Shisha. 29% patients had high normal hemoglobin between the ranges of (160-168 g/L), 17.6% patients had pre-polycythemic hemoglobin between the range of (169-171 g/L) and 53% patients were having polycythemic hemoglobin (>172 g/L). The hemoglobin level in non-smokers was 168.74 g/L, hemoglobin level in cigarette smokers was170.7 g/L, hemoglobin level in shisha smokers was 171.4 g/L while hemoglobin level in those who smokes both cigarette and shisha was 175 g/L. Smoking has adverse effects on hemoglobin. Shisha or cigarette Smoking is associated with increase in the hemoglobin levels and the severity of polycythemia. The findings may help in raising the awareness of tobacco smokers.
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Affiliation(s)
- Fatmah S. AlQahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
- Corresponding author.
| | - Farjah H. Algahtani
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mashael M. Alshebly
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fatimah M. Madkhaly
- Hematopathology Resident, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed K. Ghandour
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Jawhara H. Almalki
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Wadha S. AlOtaibi
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Asrar Salim
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Farrah C. Mendoza
- College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
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Aladağ E, Aksu S, Demiroğlu H, Sayınalp N, Göker H, Haznedaroğlu İC, Özcebe Oİ, Büyükaşık Y. Unclassifiable non-CML classical myeloproliferative diseases with microcytosis: findings indicating diagnosis of polycythemia vera masked by iron deficiency. Turk J Med Sci 2019; 49:1560-1563. [PMID: 31652037 PMCID: PMC7018294 DOI: 10.3906/sag-1907-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/02/2019] [Indexed: 11/20/2022] Open
Abstract
Background/aim Polycythemia Vera (PV) is a myeloproliferative disorder characterized by overproduction of morphologically normal red blood cells (RBCs), granulocytes, and platelets, a phenotype that is caused by a mutation (V617F) in Janus kinase 2 (JAK2). However, JAK2 V617F is also found in approximately 50% of patients with essential thrombocytosis and primary myelofibrosis, rendering its presence nonspecific as a diagnostic test. An increased red cell mass is a major criterion for the diagnosis of PV according to World Health Organization (WHO) 2016 criteria. High hemoglobin (Hgb) or Hematocrit (Hct) are universally used as indicators of an increased red cell mass for the diagnosis of PV. However, conditions such as iron deficiency (ID) with decreased mean cell volume may mask the diagnosis due to nonelevated Hct level. The aim of this study was to investigate the clinical characteristics of the patients with unclassifiable non-CML classical myeloproliferative disease with microcytosis (MPD/M) and nonelevated Hgb and Hct levels at diagnosis and to determine if some of these cases could be real PV cases masked due to ID-related microcytosis. Materials and methods There were 23 MPD/M cases among 208 non-CML classical MPD cases (11%). Among 22 patients who had adequate test results related to the cause of microcytosis, ID and beta-thalassemia trait (TT) were the apparent causes of microcytosis in 15 and 1 cases, respectively. Results Clinicopathological correlations revealed consistently positive JAK2 V617F mutation status (20/20, 100%), frequently elevated RBC count (17/23, 73.9%), and PV-compatible bone marrow findings (10/12, 83.3%). These findings are compatible with PV instead of essential thrombocytopenia or primary myelofibrosis. In spite of frequent cytoreductive treatment, 3 patients developed increased Hgb/Htc levels during median 58.2 (279–63) months’ follow-up. Conclusion These data show that the majority of MPD/M cases are PV patients masked due to ID-related microcytosis.
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Affiliation(s)
- Elifcan Aladağ
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Salih Aksu
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haluk Demiroğlu
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgün Sayınalp
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Göker
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Osman İlhami Özcebe
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yahya Büyükaşık
- Department of Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Xu L, Chen Y, Xie Z, He Q, Chen S, Wang W, Liu G, Liao Y, Lu C, Hao L, Sun J, Shi W, Liang X. High hemoglobin is associated with increased in-hospital death in patients with chronic obstructive pulmonary disease and chronic kidney disease: a retrospective multicenter population-based study. BMC Pulm Med 2019; 19:174. [PMID: 31533673 PMCID: PMC6749661 DOI: 10.1186/s12890-019-0933-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common comorbidity of chronic obstructive pulmonary disease (COPD). Although high hemoglobin (Hb) is detrimental to CKD patients, its relationship with poor outcomes in the COPD population has not been reported. This study aimed to investigate the relationship between high Hb and in-hospital mortality and to explore reference Hb intervals in patients with COPD and CKD. METHODS This retrospective study was multicenter population-based. A total of 47,209 patients who presented with COPD between January 2012 and December 2016 were included. The average Hb level during hospitalization was used as the Hb level. CKD and advanced CKD were defined as estimated glomerular filtration rates < 60 and < 30 ml/min/1.73 m2, respectively. The association between Hb level (measured in 1 g/dL intervals) and in-hospital mortality was analyzed in different multivariable logistic regression models by CKD stratification. RESULTS The Hb level was decreased in the CKD subgroup. In the non-CKD group, a higher Hb level was not associated with an increased risk of in-hospital death. However, the Hb level and mortality showed a U-shaped relationship in the CKD group. After adjusting for age and Charlson Comorbidity Index, multivariable regression analysis showed that an Hb level > 17 g/dL was associated with an increased risk of death in the CKD group with an odds ratio (OR) of 2.085 (95% CI, 1.019-4.264). Hb > 14 g/dL was related to an increased risk of death in advanced CKD patients (OR, 4.579 (95% CI, 1.243-16.866)). CONCLUSIONS High Hb is associated with an increased risk of in-hospital death in COPD patients with CKD, especially among those with advanced CKD. In this group of patients, attention should be paid to those with high Hb levels.
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Affiliation(s)
- Libin Xu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Department of Nephrology, Inner Mongolia People's Hospital, Hohhot, 010017, China
| | - Yuanhan Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhen Xie
- Department of Dermatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, 310014, China
| | - Shixin Chen
- Division of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510515, China
| | - Wenji Wang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Guohui Liu
- Department of Nephrology, Dongguan People's Hospital, Dongguan, 523018, China
| | - Yuanjiang Liao
- Department of Nephrology, Chongqing Ninth People's Hospital, Chongqing, 400700, China
| | - Chen Lu
- Department of Nephrology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - Li Hao
- Department of Nephrology, Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jin Sun
- Department of Nephrology, Second Hospital of Jilin University, Changchun, 130022, China
| | - Wei Shi
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China. .,Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Xinling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Lappin TR, Lee FS. Update on mutations in the HIF: EPO pathway and their role in erythrocytosis. Blood Rev 2019; 37:100590. [PMID: 31350093 DOI: 10.1016/j.blre.2019.100590] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022]
Abstract
Identification of the underlying defects in congenital erythrocytosis has provided mechanistic insights into the regulation of erythropoiesis and oxygen homeostasis. The Hypoxia Inducible Factor (HIF) pathway plays a key role in this regard. In this pathway, an enzyme, Prolyl Hydroxylase Domain protein 2 (PHD2), constitutively prolyl hydroxylates HIF-2α, thereby targeting HIF-2α for degradation by the von Hippel Lindau (VHL) tumor suppressor protein. Under hypoxia, this modification is attenuated, resulting in the stabilization of HIF-2α and transcriptional activation of the erythropoietin (EPO) gene. Circulating EPO then binds to the EPO receptor (EPOR) on red cell progenitors in the bone marrow, leading to expansion of red cell mass. Loss of function mutations in PHD2 and VHL, as well as gain of function mutations in HIF-2α and EPOR, are well established causes of erythrocytosis. Here, we highlight recent developments that show that the study of this condition is still evolving. Specifically, novel mutations have been identified that either change amino acids in the zinc finger domain of PHD2 or alter splicing of the VHL gene. In addition, continued study of HIF-2α mutations has revealed a distinctive genotype-phenotype correlation. Finally, novel mutations have recently been identified in the EPO gene itself. Thus, the cascade of genes that at a molecular level leads to EPO action, namely PHD2 - > HIF2A - > VHL - > EPO - > EPOR, are all mutational targets in congenital erythrocytosis.
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Affiliation(s)
- Terence R Lappin
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK.
| | - Frank S Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Tavasoli A, Arjmandi Rafsanjani K, Hemmati S, Mojbafan M, Zarei E, Hosseini S. A case of dystonia with polycythemia and hypermanganesemia caused by SLC30A10 mutation: a treatable inborn error of manganese metabolism. BMC Pediatr 2019; 19:229. [PMID: 31288771 PMCID: PMC6615235 DOI: 10.1186/s12887-019-1611-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/02/2019] [Indexed: 11/21/2022] Open
Abstract
Background Manganese is a critical trace element that not only has antioxidant properties, but also is essential for various metabolic pathways and neurotransmitters production. However, it can be toxic at high levels, particularly in the central nervous system. Manganese intoxication can be acquired, but an inherited form due to autosomal-recessive mutations in the SLC30A10 gene encoding a Mn transporter protein has also been reported recently. These mutations are associated with significant failure of manganese excretion and its storage in the liver, brain (especially basal ganglia), and other peripheral tissues, resulting in toxicity. Case presentation A 10-year-old boy from consanguineous parents presented with a history of progressive truncal instability, gait difficulty, and frequent falls for 2 months. He had dystonia, rigidity, ataxia, dysarthria, bradykinesia and a plethoric skin. Investigations showed polycythemia, low serum iron and ferritin levels, and increased total iron binding capacity. A brain MRI revealed symmetric hyperintensities in the basal ganglia and dentate nucleuses on TI images that were suggestive of brain metal deposition together with clinical manifestations. Serum calcium and copper levels were normal, while the manganese level was significantly higher than normal values. There was no history of environmental overexposure to manganese. Genetic testing showed a homozygous missense mutation in SLC30A10 (c.C1006T, p.His336Tyr) and Sanger sequencing confirmed a homozygous state in the proband and a heterozygous state in the parents. Regular treatment with monthly infusions of disodium calcium edetate and oral iron compounds resulted in decreased serum manganese and hemoglobin levels to normal values, significant resolution of MRI lesions, and partial improvement of neurological symptoms during 6 months of follow-up. Conclusion The syndrome of hepatic cirrhosis, dystonia, polycythemia, and hypermanganesemia caused by SLC30A10 mutation is a treatable inherited metal deposition syndrome. The patient may only have pure neurological without hepatic manifestations. Although this is a rare and potentially fatal inborn error of metabolism, early diagnosis and continuous chelation therapy might improve the symptoms and prevent disease progression.
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Affiliation(s)
- Azita Tavasoli
- Department of Pediatric Neurology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khadije Arjmandi Rafsanjani
- Department of Pediatric Hematology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Hemmati
- Department of Pediatrics, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Marziyeh Mojbafan
- Department of Medical Genetics and Molecular Biology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Zarei
- Department of Radiology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Hosseini
- Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
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Abstract
The regulation of erythropoiesis in the bone marrow microenvironment is a carefully orchestrated process that is dependent upon both systemic and local cues. Systemic erythropoietin (EPO) production by renal interstitial cells plays a critical role in maintaining erythropoietic homeostasis. In addition, there is increasing clinical and preclinical data linking changes in EPO and erythropoiesis to altered skeletal homeostasis, suggesting a functional relationship between the regulation of erythropoiesis and bone homeostasis. As key local components of the bone marrow microenvironment and erythropoietic niche, macrophage subsets play important roles in both processes. In this review, we summarize our current understanding of the cellular and molecular mechanisms that may facilitate the coordinated regulation of erythropoiesis and bone homeostasis.
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Affiliation(s)
- Joshua T Eggold
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Cancer Biology Program, Stanford University School of Medicine, Stanford, CA, USA
| | - Erinn B Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Cancer Biology Program, Stanford University School of Medicine, Stanford, CA, USA; Department of Obstetrics & Gynecologic Oncology, Stanford University School of Medicine, Stanford, CA, USA.
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Chothia MY, George K, Sheik M, Davids MR. Hypodipsic-hypernatremia syndrome in an adult with polycythemia: a case report. J Med Case Rep 2018; 12:381. [PMID: 30587223 PMCID: PMC6307108 DOI: 10.1186/s13256-018-1938-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background Hypernatremia is a very common electrolyte disorder and is frequently encountered in out-patient as well as in-hospital settings. We describe an adult who was found to have unexplained relative polycythemia and episodic hypernatremia. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and the patient was managed with a water-drinking schedule. Case presentation A 24-year-old South African-Indian man was found to have polycythemia in association with episodes of hypernatremia. Investigations indicated that he had relative polycythemia. He experienced no thirst at a time when his serum sodium concentration was found to be 151 mmol/L. Further testing indicated that his renal response to arginine vasopressin was intact and magnetic resonance imaging of his brain revealed no hypothalamic lesions. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and he was managed with a water-drinking schedule that corrected his hypernatremia. Conclusion Hypodipsia should always be considered when a patient without physical or cognitive disability presents with unexplained episodic hypernatremia or with relative polycythemia.
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Affiliation(s)
- Mogamat-Yazied Chothia
- Division of Nephrology, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Ward A7, Tygerberg Hospital, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.
| | - Kiran George
- Division of General Medicine, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Muhammed Sheik
- Division of General Medicine, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Mogamat Razeen Davids
- Division of Nephrology, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Ward A7, Tygerberg Hospital, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa
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Abstract
This review focuses on the management of elderly patients with chronic myeloid leukemia and chronic myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and primary myelofibrosis. Median age in these neoplasms is within the 6th decades of age. All new therapies can be done at any age without absolute contraindication. However, the selection of the precise therapy for the single patient is mandatory. For these reasons, an accurate definition of diagnosis and prognostication is necessary. Precision in disease definition and prognostication is definitively helpful for personalizing therapeutic approach.
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Affiliation(s)
- Margherita Maffioli
- Hematology, Department of Medicina Specialistica, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Ester Orlandi
- Hematology, I.R.C.C.S Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Passamonti
- Hematology, Department of Medicina Specialistica, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy; Hematology, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Kirkham FJ, Zafeiriou D, Howe D, Czarpran P, Harris A, Gunny R, Vollmer B. Fetal stroke and cerebrovascular disease: Advances in understanding from lenticulostriate and venous imaging, alloimmune thrombocytopaenia and monochorionic twins. Eur J Paediatr Neurol 2018; 22:989-1005. [PMID: 30467085 DOI: 10.1016/j.ejpn.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Fetal stroke is an important cause of cerebral palsy but is difficult to diagnose unless imaging is undertaken in pregnancies at risk because of known maternal or fetal disorders. Fetal ultrasound or magnetic resonance imaging may show haemorrhage or ischaemic lesions including multicystic encephalomalacia and focal porencephaly. Serial imaging has shown the development of malformations including schizencephaly and polymicrogyra after ischaemic and haemorrhagic stroke. Recognised causes of haemorrhagic fetal stroke include alloimmune and autoimmune thrombocytopaenia, maternal and fetal clotting disorders and trauma but these are relatively rare. It is likely that a significant proportion of periventricular and intraventricular haemorrhages are of venous origin. Recent evidence highlights the importance of arterial endothelial dysfunction, rather than thrombocytopaenia, in the intraparenchymal haemorrhage of alloimmune thrombocytopaenia. In the context of placental anastomoses, monochorionic diamniotic twins are at risk of twin twin transfusion syndrome (TTTS), or partial forms including Twin Oligohydramnios Polyhydramnios Sequence (TOPS), differences in estimated weight (selective Intrauterine growth Retardation; sIUGR), or in fetal haemoglobin (Twin Anaemia Polycythaemia Sequence; TAPS). There is a very wide range of ischaemic and haemorrhagic injury in a focal as well as a global distribution. Acute twin twin transfusion may account for intraventricular haemorrhage in recipients and periventricular leukomalacia in donors but there are additional risk factors for focal embolism and cerebrovascular disease. The recipient has circulatory overload, with effects on systemic and pulmonary circulations which probably lead to systemic and pulmonary hypertension and even right ventricular outflow tract obstruction as well as the polycythaemia which is a risk factor for thrombosis and vasculopathy. The donor is hypovolaemic and has a reticulocytosis in response to the anaemia while maternal hypertension and diabetes may influence stroke risk. Understanding of the mechanisms, including the role of vasculopathy, in well studied conditions such as alloimmune thrombocytopaenia and monochorionic diamniotic twinning may lead to reduction of the burden of antenatally sustained cerebral palsy.
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Affiliation(s)
- Fenella J Kirkham
- Developmental Neurosciences Section and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom.
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, "Hippokratio' General Hospital, Aristotle University, Thessaloniki, Greece
| | - David Howe
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom
| | - Philippa Czarpran
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom
| | - Ashley Harris
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom
| | - Roxanna Gunny
- Developmental Neurosciences Section and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Radiology, St George's hospital, London, United Kingdom
| | - Brigitte Vollmer
- Departments of Child Health, Obstetrics and Gynaecology and Radiology, University Hospital Southampton, United Kingdom; Clinical and Experimental Sciences, University of Southampton, United Kingdom
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