Kander Elizabeth M, Raza Sania, Zhou Zheng, Gao Juehua, Zakarija Anaadriana, McMahon Brandon J, Stein Brady L
Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N. Michigan Avenue, Suite 1020, Chicago, IL, 60611, USA.
Division of Hematology and Oncology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
Int J Hematol. 2015 Nov;102(5):587-93. doi: 10.1007/s12185-015-1871-4. Epub 2015 Oct 6.
The BCR-ABL1-negative myeloproliferative neoplasms (MPN) share an increased risk of thrombotic and hemorrhagic complications. Risk factors for hemorrhage are less well defined than those for thrombosis. Because patients with CALR mutations have higher platelet counts compared to JAK2 V617F-mutated patients, bleeding rates may be increased in this group. Our aim was to retrospectively evaluate whether acquired von Willebrand disease (AvWD), thrombocytosis, mutational status, or treatment history are associated with bleeding in a cohort of MPN patients. Using an electronic database, MPN patients seen between 2005 and 2013 were retrospectively identified using ICD-9 codes and billing records. A bleeding event was defined as one that was identified in the medical record and graded based on the Common Terminology Criteria for Adverse Event (CTCAE) version 4.0. Among 351 MPN patients, 15.6 % experienced 64 bleeding event types. There was no association of bleeding with mutational status, gender, MPN subtype, aspirin use, prior thrombosis, or platelet count at presentation. There was an association between bleeding and older age at diagnosis. aVWD was identified in six patients. In this single-center retrospective study, bleeding events were identified in 15 % of patients, and associated with older age at diagnosis. aVWD was rarely tested for in this cohort.
BCR-ABL1阴性骨髓增殖性肿瘤（MPN）均具有血栓形成和出血并发症风险增加的特点。与血栓形成的风险因素相比，出血的风险因素尚不明确。由于与JAK2 V617F突变患者相比，CALR突变患者的血小板计数更高，因此该组患者的出血率可能会增加。我们的目的是回顾性评估获得性血管性血友病（AvWD）、血小板增多症、突变状态或治疗史是否与一组MPN患者的出血有关。利用电子数据库，通过ICD-9编码和计费记录对2005年至2013年间就诊的MPN患者进行回顾性识别。出血事件定义为在病历中确认的事件，并根据不良事件通用术语标准（CTCAE）第4.0版进行分级。在351例MPN患者中，15.6%经历了64种出血事件类型。出血与突变状态、性别、MPN亚型、阿司匹林使用、既往血栓形成或就诊时的血小板计数均无关联。出血与诊断时年龄较大有关。6例患者被诊断为AvWD。在这项单中心回顾性研究中，15%的患者出现出血事件，且与诊断时年龄较大有关。该队列中很少检测AvWD。
