Anneli Enblom1, Emma Lindskog2, Hans Hasselbalch3, Ditte Hersby4, Marie Bak5, Jennifer Tetu6, François Girodon7, Björn Andréasson8. 1. Sunderby Hospital, Luleå, Sweden. Electronic address: Anneli.Enblom@nll.se. 2. Uddevalla Hospital, NU Hospital Group, Uddevalla, Sweden. Electronic address: emma.lindskog@vgregion.se. 3. Roskilde University Hospital, Roskilde, Denmark. Electronic address: hans.hasselbalch@dadlnet.dk. 4. Roskilde University Hospital, Roskilde, Denmark. Electronic address: dhersby@gmail.com. 5. Roskilde University Hospital, Roskilde, Denmark. Electronic address: marie_bak@hotmail.com. 6. Laboratoire D'hématologie CHU, Dijon, France. Electronic address: tetu.jennifer@gmail.com. 7. Laboratoire D'hématologie CHU, Dijon, France. Electronic address: francois.girodon@chu-dijon.fr. 8. Uddevalla Hospital, NU Hospital Group, Uddevalla, Sweden. Electronic address: bjorn.andreasson@vgregion.se.
Abstract
BACKGROUND: Vascular complications occurring before the diagnosis of myeloproliferative neoplasms (MPN) in 612 patients from four centers in Sweden, Denmark and France were retrospectively studied. RESULTS: Vascular complications were observed in 151 (25%) of the 612 patients. Of these, 66% occurred during the two years preceding diagnosis. The majority of events were thromboembolic (95%), and included myocardial infarction (n=46), ischemic stroke (n=43), transient ischemic attack (TIA) (n=22), deep vein thrombosis/pulmonary embolism (n=19), splanchnic vein thrombosis (n=7), and peripheral embolism (n=7). Bleeding was observed in only 7 (5%) of the 151 patients with vascular events (3 with intracranial bleeding, 2 with epistaxis and 2 with gastrointestinal bleeding). Full blood counts obtained at least 3 months prior to the MPN diagnosis showed that 269 (44%) had abnormal blood values, fulfilling the diagnostic criteria for MPN. During the time from the abnormal blood test to the diagnosis of MPN, 50 patients suffered from a vascular complication. CONCLUSION: We therefore conclude that a large proportion of MPN patients suffer severe thromboembolic complications prior to diagnosis. If MPN were diagnosed earlier, a large proportion of these events might be prevented. An MPN should always be suspected and ruled out in patients with unexplained elevated hematocrit, leukocyte and/or platelet counts.
BACKGROUND: Vascular complications occurring before the diagnosis of myeloproliferative neoplasms (MPN) in 612 patients from four centers in Sweden, Denmark and France were retrospectively studied. RESULTS: Vascular complications were observed in 151 (25%) of the 612 patients. Of these, 66% occurred during the two years preceding diagnosis. The majority of events were thromboembolic (95%), and included myocardial infarction (n=46), ischemic stroke (n=43), transient ischemic attack (TIA) (n=22), deep vein thrombosis/pulmonary embolism (n=19), splanchnic vein thrombosis (n=7), and peripheral embolism (n=7). Bleeding was observed in only 7 (5%) of the 151 patients with vascular events (3 with intracranial bleeding, 2 with epistaxis and 2 with gastrointestinal bleeding). Full blood counts obtained at least 3 months prior to the MPN diagnosis showed that 269 (44%) had abnormal blood values, fulfilling the diagnostic criteria for MPN. During the time from the abnormal blood test to the diagnosis of MPN, 50 patients suffered from a vascular complication. CONCLUSION: We therefore conclude that a large proportion of MPN patients suffer severe thromboembolic complications prior to diagnosis. If MPN were diagnosed earlier, a large proportion of these events might be prevented. An MPN should always be suspected and ruled out in patients with unexplained elevated hematocrit, leukocyte and/or platelet counts.
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