DOI: https://doi.org/10.26641/2307-0404.2014.1.24415

Assessing significance of peripheral blood indicators for differential diagnosis and prognosis of thrombotic complications in polycythemia vera and secondary erythrocytosis.

O. M. Kostiukevych, O. Y. Mishcheniuk, S. V. Klymenko

Abstract


The aim of the study – determining of changes in peripheral blood (PB) in patients with secondary erythrocytosis (SE) and polycythemia vera (PV), detection of discriminatory parameters levels of PB indicators and analyzing of their operating characteristics for differentiation of erythrocytosis and predicting of thrombotic events in patients with PV. Materials and methods. The material for the study was the results of clinical trials of 210 patients with erythrocytosis who underwent differential diagnosis between PV and SE. Results and discussion. The optimal threshold for differential diagnosis of red blood cells content between PV and SE is >6.08•1012/ L, the diagnostic value of the marker equals to the level of a good diagnostic marker (AUC=0.82; 95% CI=0.77-0.87, p <0.0001). Hematocrit threshold is >57.5% with its capacity – 0.72 (0.66-0.78, p <0.0001), that corresponds to the level of a middle diagnostic marker. The most pathognomonic section of white blood cells (WBC) to differentiate erythrocytosis is >8.9•109/L, and the boundary of marker is consistent with a good level of efficiency (AUC=0.79, 95% CI=0.72-0.84, p<0.0001). The efficiency criterion "platelets >287•109 /L" to differentiate erythrocytosis is 0.90 (0.86-0.94, p <0.0001).The predicting effectiveness of cardiovascular events with help of criterion "hematocrit >55%" and "WBC >12.3•109 /L", according to the AUC (AUC=0.65; 95% CI=0.52-0.79, p=0.021 and AUC=0.66; 95% CI=0.55-0.77, p=0.003, respectively), corresponds to the average power level. Conclusion. Hemoglobin has not confirmed its value for the differential diagnosis between PV and SE. Using other parameters of PB with the aim of differentiating PV and SE is rational, but their discriminatory power levels greatly depend on the group erythrocytosis. In our cohort were obtained the following most appropriate criteria for inclusion of patients in the group of patients with PV: "WBC >8.9•109/L", "red blood cells >6.08•1012/L" and "hematocrit >57.5%". The most significant marker of general clinical blood test to differentiate between PV and SE is "platelets >287•109/L". Hematocrit over 55% and WBC over 12.3·109/L are valuable prognostic markers of thrombosis in PV patients, but their use is appropriate only in a cohort of patients with PV without classical factors of cardiovascular events.

Keywords


polycythemia vera; secondary erythrocytosis; diagnostic value; peripheral blood parameters; thrombotic complications

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References


Демидова А.В. Истинная полицитемия / А.В. Де¬мидова // Клиническая онкогематология : ру¬ко¬водство для врачей / под ред. М.А. Волковой. – М.: Медицина, 2007. – С. 586–605.

Демидова А.В. Эритремия и вторичные эри¬тро¬цитозы / А.В. Демидова, Н.Н. Коцюбинский, В.И. Ма¬зуров. – СПб.: Гиппократ, 2001. – 328 с.

Истинная полицитемия / С.А. Гусєва, С.С. Бес¬смельцев, К.М Абдулкадыров, Я.П. Гончаров. – К.: Логос, 2009. – 398 с.

Hematological and iron-related analytes-reference data for persons aged 1 year and over: United States, 1988–1994 / J.G. Hollowell, O.W. van Assendelft, E.W. Gunter [et al.] // Vital Health Stat. 11. – 2005. – Vol. 247. – Р. 1–156.

Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera / R. Landolfi, L. Gennaro, T. Barbui [et al.] // Blood. – 2007. – Vol. 109. – P. 2446–2452.

McMullin M.F. Idiopathic erythrocytosis: a disappearing entity / M. F. McMullin // Hematology Am. Soc. Hematol. Educ. Program. – 2009. – Р. 629–635.

Patnaik M.M. The complete evaluation of erythro¬cytosis: congenital and acquired / M.M. Patnaik, A. Teffery // Leukemia. – 2009. – Vol. 23. – P. 834–844.

Tefferi A. Polycythemia vera and essential throm¬bocythemia: 2012 update on diagnosis, risk stratification, and management / A. Tefferi // Am. J. Hematol. – 2012. – Vol. 87. – P. 285–293.

Thomas M.A clinical approach to polycythemia / M. Thomas, K. Pavithran // Medicine Update. – 2010. – Vol. 20. – P. 577–582.

Vascular and Neoplastic Risk in a Large Cohort of Patients With Polycythemia Vera / R. Marchioli, G. Finazzi, R. Landolfi [et al.] // J. Clin. Oncol. – 2005. – Vol. 23. – P. 2224–2232.

Williams Hematology / K. Kaushansky, M. Lichtman, E. Beutler [et al.]. – 8th edn. – New York: McGraw-Hill Professional, 2010. – 2304 p.

Demidova AV. [Polycythemia vera]. Clinical oncohaematology. Guidance for doctors. Ed. M.A. Volkovoy. M. Meditsina; 2007;586–605. Russian.

Demidova AV, Kotsyubinskiy AN, Mazurov VI. [Erythremia and secondary erythrocytosis]. SPb. Gip¬pokrat; 2001:328. Russian.

Guseva SA, Bessmel'tsev SS, Abdulkadyrov KM, Goncharov YaP. [Polycythemia vera]. K. Logos; 2009:398. Russian.

Hollowell JG, van Assendelft OW, Gunter EW. Hematological and iron-related analytes-reference data for persons aged 1 year and over: United States, 1988–1994. Vital Health Stat. 11. 2005;247:1–156.

Landolfi R, Gennaro L, Barbui T. Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera. Blood. 2007;109:2446–52.

McMullin MF, McMullin F. Idiopathic erythrocytosis: a disappearing entity. Hematology Am Soc Hematol Educ Program 2009:629–35.

Patnaik MM, Teffery A. The complete evaluation of erythrocytosis: congenital and acquired. Leukemia. 2009;23:834–44.

Tefferi A. Polycythemia vera and essential thrombocythemia: 2012 update on diagnosis, risk stratification, and management. Am J Hematol. 2012;87:285–93.

Thomas M, Pavithran K. A clinical approach to polycythemia. Medicine Update. 2010;20:577–82.

Marchioli R, Finazzi G, Landolfi R. Vascular and Neoplastic Risk in a Large Cohort of Patients With Polycythemia Vera. J Clin Oncol. 2005;23:2224–32.

Kaushansky K, Lichtman M, Beutler E. Williams Hematology 8th edn. New York. McGraw-Hill Professional. 2010:2304.


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