Polycythemia Vera
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Updates in Mastocytosis
Updates in Mastocytosis Tryptase PD-L1 Tracy I. George, M.D. Professor of Pathology 1 Disclosure: Tracy George, M.D. Research Support / Grants None Stock/Equity (any amount) None Consulting Blueprint Medicines Novartis Employment ARUP Laboratories Speakers Bureau / Honoraria None Other None Outline • Classification • Advanced mastocytosis • A case report • Clinical trials • Other potential therapies Outline • Classification • Advanced mastocytosis • A case report • Clinical trials • Other potential therapies Mastocytosis symposium and consensus meeting on classification and diagnostic criteria for mastocytosis Boston, October 25-28, 2012 2008 WHO Classification Scheme for Myeloid Neoplasms Acute Myeloid Leukemia Chronic Myelomonocytic Leukemia Atypical Chronic Myeloid Leukemia Juvenile Myelomonocytic Leukemia Myelodysplastic Syndromes MDS/MPN, unclassifiable Chronic Myelogenous Leukemia MDS/MPN Polycythemia Vera Essential Thrombocythemia Primary Myelofibrosis Myeloproliferative Neoplasms Chronic Neutrophilic Leukemia Chronic Eosinophilic Leukemia, NOS Hypereosinophilic Syndrome Mast Cell Disease MPNs, unclassifiable Myeloid or lymphoid neoplasms Myeloid neoplasms associated with PDGFRA rearrangement associated with eosinophilia and Myeloid neoplasms associated with PDGFRB abnormalities of PDGFRA, rearrangement PDGFRB, or FGFR1 Myeloid neoplasms associated with FGFR1 rearrangement (EMS) 2017 WHO Classification Scheme for Myeloid Neoplasms Chronic Myelomonocytic Leukemia Acute Myeloid Leukemia Atypical Chronic Myeloid Leukemia Juvenile Myelomonocytic -
Treatment Approaches to Polycythemia Vera and Myelofibrosis
REVIEW ARTICLE Rev Hematol Mex. 2016 Apr;17(2):129-138. Treatment approaches to polycythemia vera and myelofibrosis. Palmer J, Mesa R Abstract Myeloproliferative neoplasms consist of a diverse group of disorders. Over the last 10 years, with better understanding of pathophysiology of these disorders, there are many more treatment options available to patients with these diseases. Further, improved understanding of the underlying genetic landscape has led to improved prognostication which helps identify appropriate therapeutic options. For polycythe- mia vera, initial therapy generally includes aspirin and phlebotomy. However, in patients who do not achieve an appropriate response to phlebotomy, hydroxyurea or ruxolitinib can be considered. In patients who have myelofibrosis, therapy is determined by symptom burden. In patients who have significant constitutional symptoms, a JAK inhibitor, such as ruxolitinib is an appropriate choice. There are many novel therapies under investigation for patients with myelofibrosis, including anti-fibrotic agents, novel JAK inhibitors, telomerase inhibitors and allogeneic stem cell transplant. KEYWORDS: polycythemia vera; myelofibrosis; treatment Rev Hematol Mex. 2016 abr;17(2):129-138. Enfoques terapéuticos de policitemia vera y mielofibrosis Palmer J, Mesa R Resumen Las neoplasias mieloproliferativas consisten en un diverso grupo de enfermedades. En los últimos 10 años, con mejor comprensión de estas enfermedades, hay mas opciones de tratamiento disponibles para los pacientes que las padecen. Además, el mejor entendimiento del pano- rama genético detrás de estas enfermedades ha contribuido a mejorar el pronóstico, lo que ayuda a identificar las opciones terapéuticas Mayo Clinic, Phoenix AZ, USA. adecuadas. El tratamiento inicial de la policitemia vera generalmente incluye aspirina y flebotomía. -
3Rd Year BLOOD and IMMUNOLOGY II Study Guide
BLOOD AND IMMUNOLOGY II MODULE STUDY GUIDE 3RD YEAR MBBS Contents Vision and Mission of KGMC ................................................................................................................................................................................................ Khyber Medical University: Vision ....................................................................................................................................................................................... Khyber Girls Medical College: Vision ................................................................................................................................................................................... Khyber Girls Medical College: Mission ............................................................................................................................................................................... Curriculum Committee KGMC .............................................................................................................................................................................................. Module committee ............................................................................................................................................................................................................... Outcomes of the curriculum: .............................................................................................................................................................................................. -
Polycythemia Vera Cancer Cluster Investigation in Northeast PA
Polycythemia Vera Cancer Cluster Investigation in Northeast PA Environmental toxic substances found historically in the PV cluster area and their potential for inducing DNA damage Investigating PV What is PV? PV is one of the diseases known as MPNs (myeloproliferative neoplasms). MPNs are a group of blood cancers where the bone marrow makes too many blood cells. Other illnesses included in this group of diseases are essential thrombocytosis (ET) and primary myelofibrosis (PMF). How does the body make blood cells? The body’s bone marrow contains billions of cells, but only a very tiny group plays a key role in forming blood cells (hematopoiesis). This group is composed of hematopoietic stem cells, which provide the body with a constant supply of all types of blood cells throughout life. What causes PV? The cause of PV is unknown. Scientists do know that a gene mutation (called the JAK2V617F mutation or “JAK2”) occurs in about 97% of PV cases. A gene mutation is a permanent change in the DNA sequence that makes up a gene inside the cells of a person’s body. The causes of the JAK2 mutation are also unknown. What is the history of the ATSDR PV investigation? • In 2005, local physicians and community members in Carbon, Luzerne, and Schuylkill counties raised concerns about the diagnosis of four cases of PV on the same rural road in the area where the three counties come together. • Residents also raised concerns about possible historical and current exposures to hazardous chemicals from various locations in the tri-county area. • The Pennsylvania Department of Health asked ATSDR for help investigating the cases and pattern of PV in this area of northeast Pennsylvania. -
Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis
Hindawi Publishing Corporation Case Reports in Radiology Volume 2014, Article ID 431563, 5 pages http://dx.doi.org/10.1155/2014/431563 Case Report Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis S. Fosi, V. Giuricin, V. Girardi, E. Di Caprera, E. Costanzo, R. Di Trapano, and G. Simonetti Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, University Hospital Tor Vergata, Viale Oxford 81, 00133 Rome, Italy Correspondence should be addressed to E. Di Caprera; [email protected] Received 11 April 2014; Accepted 7 July 2014; Published 17 July 2014 Academic Editor: Salah D. Qanadli Copyright © 2014 S. Fosi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT) were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. -
Essential Thrombocythemia Polycythemia Vera
n ESSENTIAL THROMBOCYTHEMIA n POLYCYTHEMIA VERA n MYELOFIBROSIS ADVOCACY & EDUCATION mpnadvocacy.com INTERNATIONAL mpnadvocacy.com MPN Advocacy & Education International MPN Advocacy and Education International provides educational programs, materials, Ann Brazeau, CEO and resources for patients, caregivers, physicians, and entire healthcare teams to improve their understanding of myelofibrosis, polycythemia vera, and essential thrombocythemia. They are dedicated to making a difference in the lives of those affected by MPNs and strive to grow awareness and advocate on behalf of the MPN community. Kathleen Michael Vice President Advocacy Our advocacy efforts extend beyond responding to the unmet needs of the MPN Community. We identify concerns in a meaningful and productive way and create initiatives that impact quality care, treatment access, new drug development and represent MPN patients and organizations who are unable to address the issues surrounding a blood cancer diagnosis. Women and MPN and Pediatric and Young Adult initiatives have expanded Dr. Ruben Mesa, MD, Scientific Advisor the interest and exploration into the unmet needs of these UT Health San Antonio patient groups. Cancer Center Education MPN Education programs are held across the country and internationally each year. Our speakers are MPN specialists who share updated information on research, clinical trials, treatment options, and comprehensive quality of life direction. Dr. Ruben Mesa, MD, is our scientific advisor and frequent speaker at our educational programs. VIEW EVENTS Please visit our website at www.mpnadvocacy.com for more information on events, advocacy initiatives, patient support groups in your area and numerous resources. PAGE ONE What are Myeloproliferative Neoplasms (MPN)? Myelo – prefix referring to bone marrow Proliferative – increasing the numbers of cells Neoplasm – any new and abnormal growth, where cell multiplication is uncontrolled and progressive. -
Consensus Guidelines for Partial Exchange Transfusion for Polycythemia in Neonates UCSF (NC)2 (Northern California Neonatal Consortium)
Consensus Guidelines for Partial Exchange Transfusion for Polycythemia in Neonates UCSF (NC)2 (Northern California Neonatal Consortium) Executive summary Objectives • Standardize the approach to screening and management of polycythemia in infants ≥ 34 weeks gestation using current practice standards and best available evidence • Improve quality and safety of care for neonates ≥ 34 weeks GA with possible polycythemia; specifically: o Improve recognition of infants showing symptoms of polycythemia o Decrease unnecessary screening o Provide recommendations on how to perform partial exchange transfusion safely and effectively o Decrease morbidity associated with unnecessary partial exchange transfusions Recommendations • Who to Screen o Asymptomatic patients should not be routinely screened regardless of risk factors o Only screen symptomatic patients for polycythemia • Who Should Receive Partial Exchange Transfusion o Do NOT perform PET in asymptomatic infant with Hct <=75% o Consider PET in infants with Hct >65% who are demonstrating signs listed in Section A or B on page 3 o Consider PET in asymptomatic infants with Hct >75%, but note there is minimal data for benefit of PET in asymptomatic infants. • Timing of Partial Exchange Transfusion o PET should be performed as soon as possible in symptomatic infants Methods This guideline was developed through local consensus based on published evidence and expert opinion as part of the UCSF Northern California Neonatal Consortium. Metrics Plan UCSF NC2 (Northern California Neonatology Consortium). -
CDHO Advisory Polycythemia, 2018-11-09
CDHO Advisory | P olycythemia COLLEGE OF DENTAL HYGIENISTS OF ONTARIO ADVISORY ADVISORY TITLE Use of the dental hygiene interventions of scaling of teeth and root planing including curetting surrounding tissue, orthodontic and restorative practices, and other invasive interventions for persons1 with polycythemia. ADVISORY STATUS Cite as College of Dental Hygienists of Ontario, CDHO Advisory Polycythemia, 2018-11-09 INTERVENTIONS AND PRACTICES CONSIDERED Scaling of teeth and root planing including curetting surrounding tissue, orthodontic and restorative practices, and other invasive interventions (“the Procedures”). SCOPE DISEASE/CONDITION(S)/PROCEDURE(S) Polycythemia INTENDED USERS Advanced practice nurses Nurses Dental assistants Patients/clients Dental hygienists Pharmacists Dentists Physicians Denturists Public health departments Dieticians Regulatory bodies Health professional students ADVISORY OBJECTIVE(S) To guide dental hygienists at the point of care relative to the use of the Procedures for persons who have polycythemia, chiefly as follows. 1. Understanding the medical condition. 2. Sourcing medications information. 3. Taking the medical and medications history. 4. Identifying and contacting the most appropriate healthcare provider(s) for medical advice. 1 Persons includes young persons and children Page | 1 CDHO Advisory | P olycythemia 5. Understanding and taking appropriate precautions prior to and during the Procedures proposed. 6. Deciding when and when not to proceed with the Procedures proposed. 7. Dealing with adverse events arising during the Procedures. 8. Keeping records. 9. Advising the patient/client. TARGET POPULATION Child (2 to 12 years) Adolescent (13 to 18 years) Adult (19 to 44 years) Middle Age (45 to 64 years) Aged (65 to 79 years) Aged 80 and over Male Female Parents, guardians, and family caregivers of children, young persons and adults with polycythemia. -
Essential Thrombocythemia Facts No
Essential Thrombocythemia Facts No. 12 in a series providing the latest information for patients, caregivers and healthcare professionals www.LLS.org • Information Specialist: 800.955.4572 Introduction Highlights Essential thrombocythemia (ET) is one of several l Essential thrombocythemia (ET) is one of a related “myeloproliferative neoplasms” (MPNs), a group of closely group of blood cancers known as “myeloproliferative related blood cancers that share several features, notably the neoplasms” (MPNs) in which cells in the bone “clonal” overproduction of one or more blood cell lines. marrow that produce the blood cells develop and All clonal disorders begin with one or more changes function abnormally. (mutations) to the DNA in a single cell; the altered cells in l ET begins with one or more acquired changes the marrow and the blood are the offspring of that one (mutations) to the DNA of a single blood-forming mutant cell. Other MPNs include polycythemia vera and cell. This results in the overproduction of blood cells, myelofibrosis. especially platelets, in the bone marrow. The effects of ET result from uncontrolled blood cell l About half of individuals with ET have a mutation production, notably of platelets. Because the disease arises of the JAK2 (Janus kinase 2) gene. The role that this from a change to an early blood-forming cell that has the mutation plays in the development of the disease, capacity to form red cells, white cells and platelets, any and the potential implications for new treatments, combination of these three cell lines may be affected – and are being investigated. usually each cell line is affected to some degree. -
Polycythemia in the Newborn
AIIMS- NICU protocols 2007 Polycythemia in the Newborn Jeeva Sankar, Ramesh Agarwal,Deepak Chawla, Vinod K Paul ,Ashok Deorari Division of Neonatology, Department of Pediatrics WHO Collaborating Centre for Training & Research in Newborn Care All India Institute of Medical Sciences Ansari Nagar, New Delhi –110029 Address for correspondence: Dr Ashok Deorari Professor Department of Pediatrics All India Institute of Medical Sciences Ansari Nagar, New Delhi 110029 Email: [email protected] Downloaded from www.newbornwhocc.org 1 AIIMS- NICU protocols 2007 Abstract Polycythemia is defined as a venous hematocrit above 65%. The hematocrit in a newborn peaks at 2 hours of age and decreases gradually after that. The etiology of polycythemia is related either to intra-uterine hypoxia or secondary to fetal transfusion. The relationship between hematocrit and viscosity is almost linear till 65% and exponential thereafter. Increased viscosity of blood is associated with symptoms of hypo-perfusion. Clinical features related to hyperviscosity may affect all organ systems and this entity should be screened for in high-risk infants. Polycythemia maybe symptomatic or asymptomatic and guidelines for management of both types based on the current evidence are provided in the protocol. Downloaded from www.newbornwhocc.org 2 AIIMS- NICU protocols 2007 Polycythemia or an increased hematocrit is associated with hyperviscosity of blood. As the viscosity increases, there is an impairment of tissue oxygenation and perfusion and a tendency to form microthrombi. Significant damage may occur if these events occur in the cerebral cortex, kidneys and adrenal glands. Hence this condition requires urgent diagnosis and prompt management. Polycythemia and Hyperviscosity The viscosity of blood is directly proportional to the hematocrit and plasma viscosity and inversely proportional to the deformability of red blood cells. -
Rethinking the Diagnostic Criteria of Polycythemia Vera
Leukemia (2014) 28, 1191–1195 & 2014 Macmillan Publishers Limited All rights reserved 0887-6924/14 www.nature.com/leu REVIEW Rethinking the diagnostic criteria of polycythemia vera T Barbui1, J Thiele2, AM Vannucchi3 and A Tefferi4 The aim of this review is to critically address the validity and clinical applicability of three major diagnostic classification systems for polycythemia vera (PV), that is, those proposed by the Polycythemia Vera Study Group (PVSG), the British Committee for Standards in Haematology (BCSH) and the World Health Organization (WHO). Special focus is on which one of the three red cell parameters (hemoglobin—HB, hematocrit—HCT and red cell mass—RCM) should be used as the diagnostic hallmark of PV. The revised BCSH employed a persistently raised HCT level as the first diagnostic criterion in combination with the presence of a JAK2V617F mutation. On the other hand, the WHO classification used a raised HB value as a surrogate for increased RCM in association with molecular markers and for the first time, the bone marrow (BM) morphology was included as a minor criterion. Ongoing controversy and discussion regards the use of certain threshold values for HCT and HB as surrogates for RCM as well as the existence of prodromal- latent disease, so-called masked PV (mPV). It has been shown that mPV can be recognized in patients not meeting the required HB or HCT threshold levels by both the WHO and BCSH criteria. These cases present with the same baseline clinical features as overt PV but present worsened survival. A critical reappraisal of the WHO criteria may suggest either to reduce the thresholds for HB or to consider HCT values as major diagnostic criterion, as in the BCSH, in association with JAK2V617F mutation. -
A Case of Acute Eosinophilic Granulocytic Leukemia with PML
Leukemia (1997) 11, 609–618 1997 Stockton Press All rights reserved 0887-6924/97 $12.00 CORRESPONDENCE CASE REPORT A case of acute eosinophilic granulocytic leukemia with PML-RAR alpha fusion gene expression and response to all-trans retinoic acid R-Q Yu1, W Huang2, S-J Chen2, S-D Jiang1 and Z Chen2 1Division of Hematology, Department of Internal Medicine, Shanghai Chang-Zheng Hospital; and 2Laboratory of Molecular Biology, Shanghai Institute of Hematology, China A typical case of eosinophilic granulocytic leukemia with PML- RAR alpha fusion gene expression is reported. The patient achieved complete remission after oral administration of all- trans retinoic acid without any exposure to cytotoxic agents. The facts strongly suggest that the genetic event occurred at the level of pluripotent stem cells. Keywords: leukemia; eosinophilic; PML-RAR alpha; retinoic acid Introduction It has been well demonstrated that the presence of a fusion gene, PML-RAR alpha, resulting from the reciprocal translo- cation of human chromosome 15 and 17, t(15;17)(q22:q21) is a specific molecular marker of acute promyelocytic leuke- mia, and plays an important role in the pathogenesis of that disease.1–4 Until now PML-RAR alpha fusion gene has not been found in other malignant cells. Recently, we saw a typi- Figure 1 Bone marrow smear showing coarse refractile eosino- cal case of acute eosinophilic granulocytic leukemia with philic granules in leukemic cells. PML-RAR alpha fusion gene expression that achieved com- plete remission after differentiation therapy with all-trans larity with a G/E ratio of 14.1:1. The differential count showed retinoic acid (ATRA).