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Cardiology 2021Polycythemia has not been extensively studied for its impact on acute coronary syndrome (ACS) outcomes. A previous study reported only 30-day outcomes to be worse in...
BACKGROUND
Polycythemia has not been extensively studied for its impact on acute coronary syndrome (ACS) outcomes. A previous study reported only 30-day outcomes to be worse in these patients.
METHODS
Data from the ACS Israeli survey between 2000 and 2018 were utilized to compare between 3 groups of patients with ACS: anemic group (hemoglobin <12 g/dL for women and <12.5 g/dL for men), normal hemoglobin group, and polycythemic group (>16 g/dL and >16.5 g/dL, respectively). Measured outcomes included 30-day major adverse cardiac events (MACE comprising all-cause mortality, recurrent ACS, need for urgent revascularization, and stroke) and 1- and 5-year all-cause mortality.
RESULTS
Of 14,746 ACS patients, 10,752 (72.9%) had normal hemoglobin levels, 3,492 (23.7%) were anemic, and 502 (3.4%) were polycythemic. In comparison with normal and anemic patients, polycythemic patients were younger (55.9 ± 10.5 vs. 61.9 ± 12.4 and 71.1 ± 12.2 for anemic, respectively, p < 0.001 for both), more frequently men (93.8% vs. 81.3% and 63.1%, respectively, p < 0.001), and less likely diabetic or hypertensive. Upon adjustment to baseline characteristics, compared with normal hemoglobin, polycythemia was not independently associated with 30-day MACE or 1-year mortality, but it was independently associated with higher risk for 5-year mortality (HR 1.76, 95% CI: 1.19-2.59, p = 0.005). Similar results were observed after propensity score matching.
CONCLUSIONS
Although younger and with fewer comorbidities, polycythemic ACS patients are at increased risk for long-term all-cause mortality. Further study of this association is warranted to understand the causes and possibly to improve the outcomes of these patients.
Topics: Acute Coronary Syndrome; Female; Humans; Hypertension; Male; Polycythemia; Surveys and Questionnaires
PubMed: 34718235
DOI: 10.1159/000519468 -
Blood Reviews Sep 2019Identification of the underlying defects in congenital erythrocytosis has provided mechanistic insights into the regulation of erythropoiesis and oxygen homeostasis. The... (Review)
Review
Identification of the underlying defects in congenital erythrocytosis has provided mechanistic insights into the regulation of erythropoiesis and oxygen homeostasis. The Hypoxia Inducible Factor (HIF) pathway plays a key role in this regard. In this pathway, an enzyme, Prolyl Hydroxylase Domain protein 2 (PHD2), constitutively prolyl hydroxylates HIF-2α, thereby targeting HIF-2α for degradation by the von Hippel Lindau (VHL) tumor suppressor protein. Under hypoxia, this modification is attenuated, resulting in the stabilization of HIF-2α and transcriptional activation of the erythropoietin (EPO) gene. Circulating EPO then binds to the EPO receptor (EPOR) on red cell progenitors in the bone marrow, leading to expansion of red cell mass. Loss of function mutations in PHD2 and VHL, as well as gain of function mutations in HIF-2α and EPOR, are well established causes of erythrocytosis. Here, we highlight recent developments that show that the study of this condition is still evolving. Specifically, novel mutations have been identified that either change amino acids in the zinc finger domain of PHD2 or alter splicing of the VHL gene. In addition, continued study of HIF-2α mutations has revealed a distinctive genotype-phenotype correlation. Finally, novel mutations have recently been identified in the EPO gene itself. Thus, the cascade of genes that at a molecular level leads to EPO action, namely PHD2 - > HIF2A - > VHL - > EPO - > EPOR, are all mutational targets in congenital erythrocytosis.
Topics: Erythropoietin; Humans; Hypoxia-Inducible Factor 1; Mutation; Polycythemia
PubMed: 31350093
DOI: 10.1016/j.blre.2019.100590 -
High Altitude Medicine & Biology Jun 2024Wang, Si-Yang, Jun Liang, and Jing-Hong Zhao. A Case of High-Altitude Renal Syndrome. 00:000-000, 2024.-Epidemiological studies have confirmed that high-altitude...
Wang, Si-Yang, Jun Liang, and Jing-Hong Zhao. A Case of High-Altitude Renal Syndrome. 00:000-000, 2024.-Epidemiological studies have confirmed that high-altitude exposure increases the risk of proteinuria. The concept of high-altitude renal syndrome (HARS) was proposed in 2011. HARS is a group of clinical syndromes consisting of high-altitude polycythemia, hyperuricemia, systemic hypertension, and microalbuminuria. At present, no standardized and unified treatment methods of HARS have been proposed. We report a case of HARS without other organ involvement in a young man exposed to high altitude. Decreasing the red blood cell count and hemodynamic changes as soon as possible may be of great importance for reducing proteinuria. In addition, angiotensin receptor blockers are effective in the treatment of HARS.
Topics: Humans; Male; Altitude Sickness; Altitude; Polycythemia; Adult; Proteinuria; Hyperuricemia
PubMed: 38335448
DOI: 10.1089/ham.2023.0077 -
Acta Haematologica 2022The diagnosis of polycythemia, particularly the secondary forms, can be challenging. The distinction between primary and secondary polycythemia is relevant and has...
The diagnosis of polycythemia, particularly the secondary forms, can be challenging. The distinction between primary and secondary polycythemia is relevant and has management implications. A systematic diagnostic workup algorithm and a good anamnesis are of paramount relevance. More than one cause may be involved in the development of polycythemia, identifying all of them will be the key to better understanding and eventually solving the polycythemia. We describe a case of a 53-year-old Swiss woman with polycythemia and a high level of carboxyhemoglobin. Her medical story included obesity and obstructive sleep apnea. The anamnesis ruled out the habit of smoking cigarettes; however, the patient reported that she was on a trip to Egypt 10 years before and bought herself a shisha; since then, she used to smoke shisha daily, at home, alone. After drastically reducing and then stopping the shisha smoking, 7 months later her blood count and carboxyhemoglobin completely normalized.
Topics: Humans; Middle Aged; Female; Smoking Water Pipes; Polycythemia; Carboxyhemoglobin; Switzerland; Smoking
PubMed: 35835029
DOI: 10.1159/000526016 -
BMC Ophthalmology Jan 2023To assess retinal structural parameters in high-altitude (HA) residents with and without high altitude polycythemia (HAPC) and to elucidate the relationship between...
BACKGROUND
To assess retinal structural parameters in high-altitude (HA) residents with and without high altitude polycythemia (HAPC) and to elucidate the relationship between retinal structural parameters and hemoglobin (HGB).
METHODS
This cross-sectional study included 55 HAPC patients and 52 healthy HA residents. Retinal structural parameters included retinal nerve fiber layer (RNFL) thickness, optic nerve head (ONH) parameters and retinal vessel diameter. RNFL thickness were acquired from spectral domain optical coherence tomography (SD-OCT) built-in software. ONH parameters including neuroretina rim height, cup area, disc area and vertical cup/disc ratio were obtained by OCT built-in software and ImageJ software. Retinal vessel measurements including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE) and AVR (artery/vein ratio) were calculated by revised formulas for summarizing retinal vessel diameters. All parameters were compared between HAPC group versus healthy HA group. The associations between retinal parameters and HGB were assessed by Pearson correlation analyses.
RESULTS
In comparison of HAPC group versus healthy HA group, RNFL thickness was thicker in the nasal quadrant of the optic disc in HAPC group (74.82 ± 14.4 VS. 66.06 ± 13.71 μm, P = 0.002). Bigger disc area and bigger cup area were also observed in HAPC group (all P < 0.05). Meanwhile, the value of CRVE was higher in HAPC group which suggested that retinal veins dilated significantly in HAPC patients (P < 0.001), however, CRAE and AVR were comparable between groups. Pearson analyses revealed that HGB was positive correlated with CRVE in HAPC group (r = 0.469, P = 0.003).
CONCLUSIONS
long-term HA exposure secondary HAPC could result in thickened RNFL, enlarged ONH and dilated retinal veins. Moreover, increased blood viscosity caused by HGB should be responsible for dilated veins, but not for thickened RNFL and enlarged ONH. This study deepens the understanding of the impact of HA environment on retina.
Topics: Humans; Altitude; Cross-Sectional Studies; Nerve Fibers; Polycythemia; Retina; Retinal Ganglion Cells; Tomography, Optical Coherence
PubMed: 36597056
DOI: 10.1186/s12886-022-02674-7 -
European Journal of Obstetrics,... Oct 2016Twin anemia polycythemia sequence (TAPS) is defined by significant intertwin hemoglobin discordance without the amniotic fluid discordance that characterizes... (Review)
Review
Twin anemia polycythemia sequence (TAPS) is defined by significant intertwin hemoglobin discordance without the amniotic fluid discordance that characterizes twin-twin-transfusion syndrome (TTTS) in monochorionic twin pregnancies. TAPS is an uncommon condition which can either occur spontaneously, or following fetoscopic laser ablation for TTTS. This complication is thought to result from chronic transfusion through very small placental anastomoses; however, the pathogenesis of TAPS remains unknown. Consequently, there is no consensus in the management of TAPS. In this article, three cases of TAPS are described and we review the literature on this uncommon pregnancy complication.
Topics: Anemia; Female; Fetofetal Transfusion; Fetoscopy; Humans; Polycythemia; Pregnancy; Pregnancy, Twin; Ultrasonography, Prenatal
PubMed: 27597647
DOI: 10.1016/j.ejogrb.2016.08.033 -
Genes Jul 2022In high-altitude environments, the prevalence of high-altitude polycythemia (HAPC) ranges between 5 and 18 percent. However, there is currently no effective treatment...
In high-altitude environments, the prevalence of high-altitude polycythemia (HAPC) ranges between 5 and 18 percent. However, there is currently no effective treatment for this condition. Therefore, disease prevention has emerged as a critical strategy against this disease. Here, we looked into the microarray profiles of GSE135109 and GSE29977, linked to either short- or long-term exposure to the Qinghai Tibet Plateau (QTP). The results revealed inhibition in the adaptive immune response during 30 days of exposure to QTP. Following a gene set enrichment analysis (GSEA) discovered that genes associated with HAPC were enriched in Cluster1, which showed a dramatic upregulation on the third day after arriving at the QTP. We then used GeneLogit to construct a logistic prediction model, which allowed us to identify 50 genes that classify HAPC patients. In these genes, and were also significantly altered following early QTP exposure, suggesting that they may serve as hub genes for HAPC development. The in-depth study of a combination of the datasets of transcriptomic changes during exposure to a high altitude and whether diseases occur after long-term exposure in Hans can give us some inspiration about genes associated with HAPC development during adaption to high altitudes.
Topics: Altitude; Altitude Sickness; Humans; Polycythemia; Tibet; Transcriptome
PubMed: 35885976
DOI: 10.3390/genes13071193 -
The New England Journal of Medicine Feb 2020
Topics: Anemia; Diseases in Twins; Female; Fetofetal Transfusion; Humans; Infant, Newborn; Placenta; Polycythemia; Pregnancy; Ultrasonography, Prenatal
PubMed: 32023377
DOI: 10.1056/NEJMicm1905895 -
Annals of Transplantation Aug 2022BACKGROUND The purpose of this study was to identify the prevalence and risk factors of post-transplant erythrocytosis (PTE) and its relationship with cytomegalovirus...
BACKGROUND The purpose of this study was to identify the prevalence and risk factors of post-transplant erythrocytosis (PTE) and its relationship with cytomegalovirus (CMV). MATERIAL AND METHODS The study consisted of patients who received a kidney allograft and followed-up in our nephrology transplantation clinic from 2000 to 2014. Patient age, sex, length of dialysis, etiology of end-stage kidney disease, date of transplantation, medications, types of donors, the development of PTE were recorded. RESULTS Among 185 adult kidney recipients, 43 (23.2%) had PTE. The average time between transplantation and diagnosis was 36 months. PTE was more common in male patients (P<0.05) and patients with living donors and those who had been treated with ganciclovir after transplantation (P<0.05). There were 79 patients treated for CMV - 54 in the non-PTE group and 24 in the PTE group. There was no significant difference in patient age, etiology of end-stage kidney disease, and immunosuppressive therapy when comparing the PTE group and non-PTE group. Univariate analysis showed ganciclovir therapy was significantly associated with PTE. However, this was not seen in the multivariate analyses. CONCLUSIONS Treatment with ganciclovir can precipitate development of PTE. Prospective studies are needed to assess the association of between PTE and CMV infection, valganciclovir, and ganciclovir.
Topics: Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Polycythemia; Risk Factors
PubMed: 35982586
DOI: 10.12659/AOT.936814 -
Medicina Clinica Jan 2020Therapeutic erythrocytapheresis (TE) is a more efficient strategy compared to phlebotomy to deplete levels of haematocrit in primary and secondary erythrocytosis.
UNLABELLED
Therapeutic erythrocytapheresis (TE) is a more efficient strategy compared to phlebotomy to deplete levels of haematocrit in primary and secondary erythrocytosis.
OBJECTIVE
To analyse response rate and safety profile of TE in polycythemia vera (PV) and secondary erythrocytosis (SE).
PATIENTS AND METHOD
Retrospective review of all patients with PV or SE treated with TE, due to phlebotomy failure, or comorbidities that prevented changes of blood volumen.
RESULTS
217 TE sessions (48 PV and 79 SE) corresponding to 20 patients (12 ES and 8 PV). Response were achieved in 87.5% of PV patients and in 50% of SE patients. Adverse effects related to TE performance occurred in 7.08%.
CONCLUSION
Despite our small sample size and the heterogeneous nature of the patients included, we can postulate that TE is a secure strategy that can achieve haematocrit depletion in a shorter time than phlebotomy, specifically in PV patients and in selected cases of SE with expected haemodynamic intolerance to phlebotomies or in patients who fail to respond to phlebotomies.
Topics: Adult; Aged; Aged, 80 and over; Cause of Death; Cytapheresis; Erythrocytes; Female; Hematocrit; Humans; Male; Middle Aged; Phlebotomy; Polycythemia; Polycythemia Vera; Retrospective Studies; Treatment Outcome
PubMed: 30795904
DOI: 10.1016/j.medcli.2018.12.016