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Role of blood cells dynamism on hemostatic complications in low-risk patients with essential thrombocythemia

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Abstract

Patients with essential thrombocythemia (ET) aged less than 60 years, who have not suffered a previous vascular event (low-risk patients), may develop thrombotic or hemorrhagic events. So far, it has not been possible to identify useful markers capable of predicting which of these patients are more likely to develop an event and therefore who needs to be treated. In the present study, we analysed the relationship between vascular complications and longitudinal blood counts of 136 low-risk ET patients taken over a sustained period of time (blood cells dynamism). After a median follow-up of 60 months, 45 out of 136 patients (33 %) suffered 40 major thrombotic and 5 severe hemorrhagic complications. A total number of 5,781 blood counts were collected longitudinally. Thrombotic and hemorrhagic events were studied together (primary endpoint) but also separately (thrombotic alone = secondary endpoint; hemorrhagic alone = tertiary endpoint). The primary endpoint showed no significant association between platelet and WBC count at diagnosis and risk of any event (platelet, p = 0.797; WBC, p = 0.178), while Hb at baseline did show an association (p = 0.024). In the dynamic analysis with Cox regression model, where the blood count values were studied by time of follow-up, we observed that the risk for Hb was 1.49 (95 % CI 1.13–1.97) for every increase of 1 g/dL, and that this risk then marginally decreased during follow-up. WBC was associated with an increased risk at baseline for every increase of 1 × 109/L (hazard ratio (HR) 1.07, 95 % CI 1.01–1.13, p = 0.034), the risk was stable during follow-up (HR 0.95, p = 0.187 at 60 months). Also, for each increment at baseline of 100 × 109 platelets/L, HR was increased by 1.08 (95 % CI 0.97–1.22, p = 0.159) and decreases during follow-up. In conclusion, this study is the first to evaluate in ET low-risk patients, the risk of developing a thrombotic/hemorrhagic event considering blood counts over time. Overall our study shows that the risk changes over time. For example, the risk associated with WCC is not linear as previously reported. An interesting new finding is that PLT and even Hb contribute to the risk of developing vascular events. Future treatments should take into consideration these findings and aim to control all parameters over time. We believe this early study may help develop a dynamic analysis model to predict thrombosis in the single patient. Further studies are now warranted to further validate our findings.

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Acknowledgments

We acknowledge the contribution of Ms. Verena Rossi for her professional help designing the database and helping during data collection.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Haematology, San Maurizio Regional Hospital, Bolzano, South Tyrol, Italy

    Andrea Piccin, Irene Pusceddu, Alessandra Marabese, Daisy Corvetta & Sergio Cortelazzo

  2. Division of Haematology & Oncology, University Hospital, Innsbruck, Austria

    Andrea Piccin, Michael Steurer, Elisabeth Maria Blöchl & Günther Gastl

  3. Oncohaematology Unit, Meran Hospital, Merano, South Tyrol, Italy

    Manfred Mitterer

  4. Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy

    Luigi Marcheselli

  5. Department of Internal Medicine, University of Medicine, Padua, Italy

    Irene Bertozzi & Maria Luigia Randi

  6. Department of Haematology, University of Milano Bicocca, Milan, Italy

    Elena Elli & Enrico Maria Pogliani

  7. Department of Medicine, Section of Hematology, University of Verona, Verona, Italy

    Dino Veneri, Omar Perbellini, Mauro Krampera & Giovanni Pizzolo

  8. Department of Haematology, Cà Foncello Hospital, Treviso, Italy

    Enrica Pacquola, Michele Gottardi & Filippo Gherlinzoni

  9. Department of Haematology, Azienda Ospedaliero-Universitaria, Udine, Italy

    Mario Tiribelli

  10. Department of Haematology, Santa Chiara Hospital, Trento, Italy

    Anna Guella, Barbara Innella & Paolo Vivaldi

  11. Department of Haematology, Camposampiero Hospital, Padua, Italy

    Ercole De Biasi

  12. Department of Haematology, Venice Hospital, Venice, Italy

    Rosaria Sancetta, Roberta Rocconi & Renato Bassan

Authors
  1. Andrea Piccin
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  2. Michael Steurer
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  3. Manfred Mitterer
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  4. Elisabeth Maria Blöchl
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  5. Luigi Marcheselli
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  6. Irene Pusceddu
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  7. Alessandra Marabese
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  8. Irene Bertozzi
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  9. Daisy Corvetta
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  10. Maria Luigia Randi
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  11. Elena Elli
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  12. Enrico Maria Pogliani
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  13. Dino Veneri
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  14. Omar Perbellini
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  15. Mauro Krampera
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  16. Enrica Pacquola
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  17. Michele Gottardi
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  18. Mario Tiribelli
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  19. Anna Guella
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  20. Barbara Innella
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  21. Paolo Vivaldi
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  22. Ercole De Biasi
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  23. Rosaria Sancetta
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  24. Roberta Rocconi
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  25. Renato Bassan
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  26. Filippo Gherlinzoni
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  27. Giovanni Pizzolo
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  28. Günther Gastl
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  29. Sergio Cortelazzo
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Corresponding author

Correspondence to Andrea Piccin.

Additional information

This work represents part of the thesis of Dr. Elisabeth Maria Blöchl, which has been presented and recently approved as a MD diploma thesis at the Department of Oncohaematology of Innsbruck Medicine University, Austria (Professor Günther Gastl and Prof Michael Steurer).

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Piccin, A., Steurer, M., Mitterer, M. et al. Role of blood cells dynamism on hemostatic complications in low-risk patients with essential thrombocythemia. Intern Emerg Med 10, 451–460 (2015). https://doi.org/10.1007/s11739-015-1186-8

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  • DOI: https://doi.org/10.1007/s11739-015-1186-8

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