Simini Giulia, Innes Andrew, Vinayagam Saravanan, Mobayen Golzar, Karawitage Nilanthi, Claudiani Simone, Odho Zain, Laffan Mike, Arachchillage Deepa J
Department of Haematology, Imperial College Healthcare National Health Service Trust, London, UK.
Department of Haematology, Cancer Institute, University College London, London, UK.
Res Pract Thromb Haemost. 2025 Jun 24;9(5):102954. doi: 10.1016/j.rpth.2025.102954. eCollection 2025 Jul.
Myeloproliferative neoplasms (MPNs) represent a group of blood disorders characterized by myeloid cell proliferation and an associated increased risk of thrombosis and bleeding. Platelet count may have a direct link to these complications.
To share our MPN clinic's experience with hemostatic testing and bleeding outcomes in patients with platelets ≥ 800 × 10/L.
This was a single-center retrospective study from May 2022 to September 2024. Clinical characteristics, treatments, and bleeding events of patients with MPN or chronic myeloid leukemia were recorded. Laboratory assessments included full blood count, renal function, coagulation profiles, platelet function test, and von Willebrand factor (VWF) assays.
A total of 39 patients were included, majority of whom received aspirin for thrombosis prevention (76%). The study found that bleeding complications occurred in 33% of patients, with mucocutaneous bleeding being the most common. There was a trend toward bleeding in patients on aspirin ( = .07). However, platelet count alone did not predict bleeding risk. While some patients showed abnormal VWF function, low VWF levels were not consistently associated with increased bleeding. Interestingly, we found moderate negative correlation between baseline VWF ristocetin/antigen and activated partial thromboplastin time ( = .02; = -.37) and prothrombin time ( = .009, = -.45), suggesting other potential coagulation imbalances associated with bleeding diathesis in MPNs. Post cytoreduction, there was a significant increase in mean VWF ristocetin/antigen ratio ( = .0009).
The study illustrates the limitations of relying solely on platelet counts to estimate bleeding risk in MPN patients. Assessment of VWF activity and careful selection of antithrombotic therapy were highlighted as important considerations.
骨髓增殖性肿瘤（MPN）是一组以髓系细胞增殖以及血栓形成和出血风险增加为特征的血液疾病。血小板计数可能与这些并发症直接相关。
分享我们MPN诊所对血小板计数≥800×10⁹/L患者进行止血检测和出血结局的经验。
这是一项2022年5月至2024年9月的单中心回顾性研究。记录了MPN或慢性髓系白血病患者的临床特征、治疗方法和出血事件。实验室评估包括全血细胞计数、肾功能、凝血指标、血小板功能测试和血管性血友病因子（VWF）检测。
共纳入39例患者，其中大多数（76%）接受阿司匹林预防血栓形成。研究发现33%的患者发生出血并发症，最常见的是皮肤黏膜出血。服用阿司匹林的患者有出血趋势（P = 0.07）。然而，仅血小板计数并不能预测出血风险。虽然一些患者显示VWF功能异常，但低VWF水平与出血增加并无一致关联。有趣的是，我们发现基线VWF瑞斯托霉素辅因子/抗原与活化部分凝血活酶时间（P = 0.02；r = -0.37）和凝血酶原时间（P = 0.009，r = -0.45）之间存在中度负相关，提示MPN中与出血倾向相关的其他潜在凝血失衡。细胞减灭术后，平均VWF瑞斯托霉素辅因子/抗原比值显著增加（P = 0.0009）。
该研究说明了仅依靠血小板计数来评估MPN患者出血风险的局限性。强调评估VWF活性和谨慎选择抗血栓治疗是重要的考虑因素。
