Esansiyel trombositemi hastalarında kemik iliği fibrozisi ile ortalama trombosit hacmi ve plateletkritin ilişkisi: Bir kohort çalışma

Öz

Amaç: Esansiyel trombositemi (ET) hastalarında ortalama trombosit hacmi (MPV) değerleri sağlıklı bireylere göre daha yüksek seyretmektedir. Ancak, ET’da MPV veya plateletkritin (PCT) kemik iliği fibrozisi (KİF) derecesi ile ilişkisi henüz araştırılmamıştır. Amacımız MPV ve PCT değerlerinin ET hastalarında kemik iliği fibrozisini değerlendirmede prediktif bir belirteç olarak rolünü araştırmaktır.

Yöntemler: Retrospektif bir kohort çalışması yaparak Ocak 2015 ile Aralık 2016 arasında hematoloji polikliniğimizden takip edilen ET hastalarının verilerini inceledik. 18 yaşından büyük, tanı anında kemik iliği biyopsisi, hemogram, biyokimya ve batın ultrasonu olan, JAK2 istenmiş olan ve BCR-ABL negatif hastalar çalışmaya dâhil edildi. Hastalar KİF varlığına göre “KİF grubu” ve “KİF olmayan grup” olarak iki gruba ayrıldı. MPV ve PCT için eşik değer için ortanca değer alındı. Karşılaştırmalı istatistiksel analizler için Fisher exact ve ki kare testi kullanıldı.

Bulgular: Hastaların 22’si erkek 26’sı kadın olup ortanca yaş 56 yaştı (Aralık 28-81). KİF grubunda 35 (%73) hasta varken KİF olmayan grupta 13 (%27) hasta mevcuttu. Medyan MPV 8,8 fL (6,6-11,5) iken medyan PCT %0,69 (0,42-2,26) idi ve bunlar iki parametre için eşik değer olarak kullanıldı. KİF varlığı ile MPV ≤8,8 fL ve MPV >8,8 fL olan hastalar arasında, PCT ≤%0,69 ve PCT >%0,69 olanlardaki gibi anlamlı fark bulunmamaktaydı (p=0,104 ve 0,616). 

Sonuç: Çalışmamızda ET hastalarında KİF ile MPV veya PCT arasında ilişki bulamadık. Bununla birlikte çalışmamız ET hastalarında KİF’ni öngörmede MPV ve PCT’nin rolünü araştıran ilk çalışmadır.

Anahtar Kelimeler

• Esansiyel trombositemi,Ortalama trombosit hacmi,Plateletkrit,Kemik iliği fibrozisi

The association of mean platelet volume and platecrit and bone marrow fibrosis in patients with essential thrombocythemia: A cohort study

Abstract

Aim: Essential thrombocythemia (ET) patients exhibit higher mean platelet volume (MPV) values compared to the healthy individuals. However, the association of degree of bone marrow fibrosis with either MPV or platecrit (PCT) has not been evaluated previously. The aim of this study was to investigate MPV and PCT values as predictive markers for evaluating bone marrow fibrosis (BMF) in ET patients. 

Methods: We conducted a retrospective cohort study to analyze the data of ET patients, who were followed in out-patient clinic of our hematology department, between January 2015 and December 2016. Patients older than 18 years, who had bone marrow biopsy, CBC, biochemistry tests and an abdominal sonography performed at the time of diagnosis, JAK2 test ordered and were BCR-ABL negative were included in the study. The patients were divided into two groups according to the presence of BMF as “the BMF group” and “the non-BMF group”. The cut-off value for MPV and PCT was determined according to the median value. Fisher’s exact test and χ2 were used for comparative statistical analysis.

Results: There were 22 males and 26 females with a median age of 56 years (range, 28–81). The BMF group included 35 (73%) patients while the non-BMF group included 13 (27%) patients. The median MPV was 8.8 fL (6.6-11.5) and median PCT was 0.69% (0.42-2.26), which was considered as the cut-off values for these parameters. There was no significant difference between the groups in patients with MPV ≤8.8 fL and MPV >8.8 fL (p=0.104) and also in patients with PCT ≤0.69% and PCT >0.69% (p=0.616).

Conclusion: There is no association between the BMF and MPV and PCT in ET patients. However this is the first study investigating the role of both MPV and PCT in BMF in ET patients.

Keywords

• Essential thrombocythemia,Mean platelet volume,Platecrit,Bone marrow fibrosis

Kaynakça

1. 1. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al, 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127:2391-405.
2. 2. Tefferi A, Barbui T. Personalized management of essential thrombocythemia: application of recent evidence to clinical practice. Leukemia. 2013;27:1617-20.
3. 3. Tefferi A, Pardanani A. Myeloproliferative neoplasms: A contemporary review. JAMA. Oncol. 2015;1:97-105.
4. 4. Goto S, Hasebe T, Takagi S. Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis - Translation From Basic Science to Clinical Medicine. Circ. J. 2015;79(9):1871-81.
5. 5. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest. 2005;115:3378-84.
6. 6. Choi DH, Kang SH, Song H. Mean platelet volume: a potential biomarker of the risk and prognosis of heart disease. Korean J Intern Med. 2016;31(6):1009-1017.
7. 7. Bath PM, Butterworth RJ. Platelet size: measurement, physiology and vascular disease. Blood Coagul Fibrinolysis. 1996;7:157-61.
8. 8. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.

9. 9. Graham SS, Traub B, Mink IB. Automated platelet-sizing parameters on a normal population. Am J Clin Pathol. 1987;87(3):365-9.
10. 10. Kissova J, Bulikova A, Ovesna P, Bourkova L, Penka M. Increased mean platelet volume and immature platelet fraction as potential predictors of thrombotic complications in BCR/ABL-negative myeloproliferative neoplasms. Int J Hematol. 2014;100(5):429-36.
11. 11. Toprak SK, Erismis B, Karakus S, Kursun N, Haberal A, Ulusoy MG. Does thrombocyte size give us an idea about thrombocytosis etiology? Scientific World Journal. 2012;2012:598653.
12. 12. Tefferi A, Vardiman JW. Classification and diagnosis of myeloproliferative neoplasms: The 2008 World Health Organization criteria and point-of-care diagnostic algorithms. Leukemia. 2008;22:14-22.
13. 13. Thiele J, Kvasnicka HM, Facchetti F, Franco V, van der Walt J, Orazi A. European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica. 2005 Aug; 90(8):1128-32
14. 14. Chuzi S, Stein BL. Essential thrombocythemia: a review of the clinical features, diagnostic challenges, and treatment modalities in the era of molecular discovery. Leuk Lymphoma. 2017;15:1-13.
15. 15. Cerquozzi S, Tefferi A. Blast transformation and fibrotic progression in polycythemia vera and essential thrombocythemia: a literature review of incidence and risk factors. Blood Cancer J. 2015;5:e366.
16. 16. Tefferi A. Myeloproliferative neoplasms: A decade of discoveries and treatment advances. Am J Hematol. 2016;91(1):50-8.
17. 17. Tang YT, He P, Li YZ, Chen HZ, Chang XL, Xie QD, et al. Diagnostic value of platelet indices and bone marrow megakaryocytic parameters in immune thrombocytopenic purpura. Blood Coagul Fibrinolysis. 2017;28(1):83-90.
18. 18. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010;8(1):148-56.
19. 19. Turfan M, Erdogan E, Ertas G, Duran M, Murat SN, Celik E, et al. Usefulness of mean platelet volume for predicting stroke risk in atrial fibrillation patients. Blood Coagul Fibrinolysis. 2013;24(1):55-8.
20. 20. Sansanayudh N, Numthavaj P, Muntham D, Yamwong S, McEvoy M, Attia J, et al. Prognostic effect of mean platelet volume in patients with coronary artery disease. A systematic review and meta-analysis. Thromb Haemost. 2015;114(6):1299-309.
21. 21. Zaccardi F, Rocca B, Pitocco D, Tanese L, Rizzi A, Ghirlanda G. Platelet mean volume, distribution width, and count in type 2 diabetes, impaired fasting glucose, and metabolic syndrome: a meta-analysis. Diabetes Metab Res Rev. 2015;31(4):402-10.
22. 22. Madan SA, John F, Pitchumoni CS. Nonalcoholic Fatty Liver Disease and Mean Platelet Volume: A Systemic Review and Meta-analysis. J Clin Gastroenterol. 2016;50(1):69-74.
23. 23. Lei JJ, Zhou L, Liu Q, Xiong C, Xu CF.Can mean platelet volume play a role in evaluating the severity of acute pancreatitis? World J Gastroenterol. 2017;23(13):2404-13.
24. 24. Pyo JS, Sohn JH, Kang G. Diagnostic and prognostic roles of the mean platelet volume in malignant tumors: a systematic review and meta-analysis. Platelets. 2016;27(8):722-8.
25. 25. Celık T, Balta S, Demır M, Yıldırım AO, Kaya MG, Ozturk C, et al. Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiol J. 2016;23(1):84-92.
26. 26. Uğur M, Ayhan E, Bozbay M, Çiçek G, Ergelen M, Işık T, et al. The independent assocıatıon of plateletcrıt wıth long-term outcomes in patıents undergoıng prımary percutaneous coronary interventıon. J Crit Care. 2014;29(6):978-81.
27. 27. Kim MJ, Park PW, Seo YH, Kim KH, Seo JY, Jeong JH, et al. Comparison of platelet parameters in thrombocytopenic patients associated with acute myeloid leukemia and primary immune thrombocytopenia. Blood Coagul Fibrinolysis. 2014;25(3):221-25.
28. 28. Cikrikcioglu MA, Celik K, Ekinci I, Nasifov M, Toprak AE, Cetin G, et al. Mean Platelet Volume in Heterozygous Beta Thalassaemia. Acta Haematol. 2017;137(2):100-5.
29. 29. Prajs I, Kuliczkowski K. Predictive factors of thrombosis for patients with essential thrombocythaemia: A single center study. Adv Clin Exp Med. 2017;26(1):115-21.