Beyond Hemoglobin: When and How to Work Up Possible Polycythemia Vera
| Autor: | Gene Shaw, Richard L. Berg |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male 030213 general clinical medicine medicine.medical_specialty Adolescent Mutation Missense Gastroenterology World health Hemoglobins 03 medical and health sciences 0302 clinical medicine Polycythemia vera Internal medicine medicine Humans Polycythemia Vera Original Research Aged Community and Home Care Platelet Count business.industry General Medicine Janus Kinase 2 Middle Aged medicine.disease Work-up medicine.anatomical_structure Amino Acid Substitution Erythropoietin Female Who criteria Hemoglobin Bone marrow Secondary erythrocytosis business medicine.drug |
| Zdroj: | Clinical Medicine & Research. 18:11-20 |
| ISSN: | 1554-6179 1539-4182 |
| DOI: | 10.3121/cmr.2019.1483 |
| Popis: | BACKGROUND: World Health Organization (WHO) 2017 diagnostic criteria for hemoglobin levels in polycythemia vera (PV) were lowered from 185 g/L to 165 g/L for men and from 165 g/L to 160 g/L for women, but these cutoffs were not designed for screening. OBJECTIVES: The primary aim of this study was to assess the value of laboratory and clinical parameters in deciding whether to further pursue a diagnosis of PV. A secondary aim was to explore the diagnostic utility of bone marrow morphology. METHODS: We evaluated clinical and laboratory parameters that may be useful when considering further diagnostic work-up, emphasizing PV vs. secondary erythrocytosis (SE). We classified 200 patients with JAK2 V617F testing using WHO criteria. RESULTS: Patients with myeloproliferative neoplasms (MPN) were rarely under age 40 and uncommonly obese (BMI ≥ 30 kg/m(2)). Current smoking history favored SE, and these patients rarely had a platelet count ≥ 450 × 10(3)/uL. Laboratory parameters suggesting greater PV likelihood were: RBC > 6.8 × 10(6) for men or > 5.9 × 10(6) for women; low erythropoietin; and low MCV or low ferritin. Bone marrow morphology (available in 111 cases) was generally more cellular in PV vs. SE and assessed disease progression. CONCLUSIONS: Readily accessible clinical and laboratory data can assist in considering a PV workup, and a possible diagnostic algorithm is presented. These preliminary findings warrant larger studies to develop a more formal PV-risk scoring system with optimal cutoffs and weighting. |
| Databáze: | OpenAIRE |
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