Contributions
Abstract: PB2131
Type: Publication Only
Background
Under diagnosis related to the earlier hemoglobin (Hb) or hematocrit (Hct) diagnostic criterion is one reason to the 2016 revision of the diagnosis of PV in the World Health Organization (WHO) classification of Tumours of Haematopoetic and Lymphoid tissues. Bone Marrow Biopsy (BM) and molecular markers (JAK2) are recommended to establish the diagnosis in those with the lower threshold(Arber DA et al,2016). This potentially could result in increased numbers and costs of investigations. The lower thresholds are aimed to identify those previously referred to as masked PV (mPV) who have been recognized to have an increased incidence of thrombosis (Barbui T et al, 2014 & 2015).We hypothesized that the revision would increase the incidence of patients with Ischaemic stroke and potential PV who would then require additional investigations.
Aims
To determine number of patients with young strokes with potential PV on application of the 2016 revised WHO criteria for PV .
Methods
We undertook an analysis of records of patients with ischemic stroke prospectively maintained in the The Indo-US Stroke Registry and Infrastructure Development Project.
Results
There were 24 (1.2%) patients with potential PV which was revised to 107 (5.2%) on applying the 2016 Hb criterion. The exact McNemar's test determined that there was a statistically significant difference in the proportion of polycythemics, p = .000. Considering the potential of comorbidities in the elderly to confound the association of polycythemia with Ischaemic stroke, we separately analyzed only those with young stroke (Age < 45). In this cohort there were 420 patients. A total of 6 (1.4%) patients had potential PV based on the 2008 Hb criteria. On applying the 2016 revision; 37 (8.8%) patients fulfilled the Hb criteria. An exact McNemar's test determined that there was a statistically significant difference in the proportion of polycythemics, p = .000. Separate analyses by gender was not significant in females, P=0.5; but significant in males, p = .000. There were an additional 29 males with the revised criteria for polycythemia.
Conclusion
The present data shows that there exists a significant difference in the incidence of polycythemia in thrombosis (Ischaemic Stroke) on applying the revised criteria. The requirement to additionally investigate them with BM and molecular markers for PV has potential economic implications.
Session topic: 35. Quality of life, palliative care, ethics and health economics
Keyword(s): Stroke, Polycythemia vera, WHO classification
Abstract: PB2131
Type: Publication Only
Background
Under diagnosis related to the earlier hemoglobin (Hb) or hematocrit (Hct) diagnostic criterion is one reason to the 2016 revision of the diagnosis of PV in the World Health Organization (WHO) classification of Tumours of Haematopoetic and Lymphoid tissues. Bone Marrow Biopsy (BM) and molecular markers (JAK2) are recommended to establish the diagnosis in those with the lower threshold(Arber DA et al,2016). This potentially could result in increased numbers and costs of investigations. The lower thresholds are aimed to identify those previously referred to as masked PV (mPV) who have been recognized to have an increased incidence of thrombosis (Barbui T et al, 2014 & 2015).We hypothesized that the revision would increase the incidence of patients with Ischaemic stroke and potential PV who would then require additional investigations.
Aims
To determine number of patients with young strokes with potential PV on application of the 2016 revised WHO criteria for PV .
Methods
We undertook an analysis of records of patients with ischemic stroke prospectively maintained in the The Indo-US Stroke Registry and Infrastructure Development Project.
Results
There were 24 (1.2%) patients with potential PV which was revised to 107 (5.2%) on applying the 2016 Hb criterion. The exact McNemar's test determined that there was a statistically significant difference in the proportion of polycythemics, p = .000. Considering the potential of comorbidities in the elderly to confound the association of polycythemia with Ischaemic stroke, we separately analyzed only those with young stroke (Age < 45). In this cohort there were 420 patients. A total of 6 (1.4%) patients had potential PV based on the 2008 Hb criteria. On applying the 2016 revision; 37 (8.8%) patients fulfilled the Hb criteria. An exact McNemar's test determined that there was a statistically significant difference in the proportion of polycythemics, p = .000. Separate analyses by gender was not significant in females, P=0.5; but significant in males, p = .000. There were an additional 29 males with the revised criteria for polycythemia.
Conclusion
The present data shows that there exists a significant difference in the incidence of polycythemia in thrombosis (Ischaemic Stroke) on applying the revised criteria. The requirement to additionally investigate them with BM and molecular markers for PV has potential economic implications.
Session topic: 35. Quality of life, palliative care, ethics and health economics
Keyword(s): Stroke, Polycythemia vera, WHO classification