Plateletpheresis in the management of thrombocytosis

Taft, Edwin G.; Babcock, Robert B.; Scharfman, William B.; Tartaglia, Anthony P.

doi:10.1182/blood.v50.5.927.927

Cited by 55 publications

(8 citation statements)

References 6 publications

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“… 2 For acute management of extreme thrombocytosis with acute MI in this patient, we used plateletpheresis to rapidly reduce platelets before attaining the effects of the platelet-lowering agent. Although therapeutic plateletpheresis was only a weak recommendation according to current apheresis guidelines, 17 this strategy was effective in ameliorating symptoms due to thrombocytosis in PV and ET in the previous case series 18 and possibly had benefits in terms of prevention of early recurrent MI in this case report. For long-term management of PV, phlebotomy was omitted due to the fact that the hematocrit in this case was already less than 45%, which is the current target that was confirmed in the randomized trial.…”

Section: Discussionmentioning

confidence: 61%

Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera

et al. 2015

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Thrombosis is a major complication of polycythemia vera (PV) and also a well-known complication of thalassemia. We reported a case of non-atherosclerotic ST-segment elevation myocardial infarction (STEMI) in a 17-year-old man with concurrent post-splenectomized hemoglobin H-Constant Spring disease and JAK2 V617F mutation-positive PV. The patient initially presented with extreme thrombocytosis (platelet counts greater than 1,000,000/µL) and three months later developed an acute STEMI. Coronary artery angiography revealed an acute clot in the right coronary artery without atherosclerotic plaque. He was treated with plateletpheresis, hydroxyurea and antiplatelet agents. The platelet count decreased and his symptoms improved. This case represents the importance of early diagnosis, awareness of the increased risk for thrombotic complications, and early treatment of PV in patients who have underlying thalassemia with marked thrombocytosis.

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Section: Discussionmentioning

confidence: 61%

Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera

et al. 2015

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“…In 1977, Taft and colleagues reported the use of discontinuous flow (Haemonetics model) and continuous flow (Aminco Celltrifuge) centrifugation for plateletpheresis in 5 patients with acute complications of thrombocytosis: cerebrovascular events in a woman with polycythemia vera (PV), pulmonary embolism in a man with thrombocytosis secondary to splenectomy, painful extremities and headache in a female splenectomy patient, cardiovascular symptoms and GI bleeding in a man with PV, and sensory deficit and paresis in a woman with thrombocythemia (type not specified) (42). In each case, the treatment was effective in preventing additional morbidity and relieving symptoms.…”

Section: Plateletpheresis For Acute Eventsmentioning

confidence: 99%

“…Since drug therapy usually takes several days and sometimes weeks to reduce platelet counts effectively, therapeutic plateletpheresis is indicated in patients with ET when a rapid reduction in platelet counts is necessary (41,42). Patients considered most likely to benefit are those with life‐threatening organ dysfunction, particularly neurologic or pulmonary (41).…”

Section: Treatmentmentioning

confidence: 99%

“…Aspirin is considered inadvisable in such cases, and since anagrelide or hydroxyurea may not have a sufficiently rapid onset of action, plateletpheresis is effective alternative therapy for the management of acute symptoms in this situation (16). Because the beneficial effect of plateletpheresis is generally quite brief and repeat procedures are often necessary, it is recommended also that cytoreductive therapy be started as soon as possible for long‐term control of the platelet count (41,42).…”

Section: Treatmentmentioning

confidence: 99%

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The Role of Blood Component Removal in Essential and Reactive Thrombocytosis

Greist

2002

Therapeutic Apheresis

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An elevated platelet count is now a common finding in both hospitalized and ambulatory patients with the advent of automated complete blood cell counters. Clinicians may be called upon to make a distinction between a reactive process and a primary hematologic disorder as the cause of a thrombocytosis and to determine whether treatment is indicated. Essential thrombocythemia and other myeloproliferative disorders may present with marked increases in the platelet counts and may be associated with thrombohemorrhagic complications. Reactive thrombocytosis can be caused by iron deficiency and a variety of inflammatory conditions, infections, malignancy, bleeding or hemolysis, splenectomy, and drugs. Acute therapy for all of these disorders has included blood component removal, specifically plateletpheresis. The role of plateletpheresis in current management of thrombocytosis is considered, based on current knowledge of pathophysiology and a review of the literature.

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“…Extreme thrombocytosis in the context of a chronic myeloproliferative disease may manifest with either bleeding or thrombosis. The combination of symptoms and a platelet count exceeding 1,000,000/µl may warrant emergency plateletpheresis to immediately reduce the platelet count by 45%-70% [29,30]. A single procedure is usually adequate treatment, providing that chemotherapy is started at the same time.…”

Section: Pineda Vamvakas 98mentioning

confidence: 99%

Applications of Therapeutic Apheresis in Patients with Malignant Disease

Pineda

Vamvakas

1997

The Oncologist

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Therapeutic apheresis (TA) provides the means for the removal of blood components that are abnormal or that circulate in excessive amounts and have a defined pathogenetic role, or are thought to have one. Multiple disease processes have been treated with TA at one time or another, but scientific assessment of the therapeutic effects of the procedure has lagged behind application of the technology. This led the American Medical Association and the American Society for Apheresis to publish position papers on the proper applications of TA. In the field of oncology, therapeutic plasma exchange (TPE) and related procedures may be the treatment of choice for some conditions (e.g., TPE for thrombotic thrombocytopenic purpura, therapeutic leukapheresis for extreme leukocytosis in acute myelogenous leukemia, etc.), or may represent a promising therapeutic modality whose efficacy needs to be established by randomized controlled trials in the future (e.g., photopheresis for the treatment of cutaneous graft-versus-host disease). Some applications should be considered strictly investigational, and should be offered to patients only if they are part of an approved research protocol (e.g., extracorporeal immunoadsorption with staphylococcal protein A for non-hematologic cancer). Routine use of TA should be restricted to conditions where the benefit has been established by controlled studies or the best available evidence.

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Plateletpheresis in the management of thrombocytosis

Cited by 55 publications

References 6 publications

Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera

Acute Non-Atherosclerotic ST-Segment Elevation Myocardial Infarction in an Adolescent with Concurrent Hemoglobin H-Constant Spring Disease and Polycythemia Vera

The Role of Blood Component Removal in Essential and Reactive Thrombocytosis

Applications of Therapeutic Apheresis in Patients with Malignant Disease

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