PURPOSE: In patients with malignancies, thrombocytosis has been related to the disease stage and survival rate. In this study, special interest was directed to the possible prognostic significance of the platelet counts at diagnosis in patients with gastric cancer. METHODS: Three hundred and sixty-one patients with histologically confirmed gastric cancer who were underwent surgery at the Department of Surgery, Hanyang University Hospital, between January 1994 and December 1998 were reviewed. The relationship between the platelet count (PLT: 10(9)/L), the total WBC count (10(9)/L), the hemoglobin concentration (Hb; g/mL), the serum albumin (g/liter), the disease progression, and the survival rate of the patients were investigated. RESULTS: Thrombocytosis (PLT greater than 400) was present in 29 patients (8.0%) and anemia (Hb less than 12) was present in 130 patients (36.0%). The mean value of the PLT count increased significantly according to the advancement of the disease stage (stage I; 242, stage II; 258, stage III; 277, stage IV; 288, P value=0.000). The hemoglobin concentrations were negatively correlated with the platelet counts (gamma=-0.257, P=0.000). The prevalence of thrombocytosis was 3.0% and 8.3% in patients with stages I and II, respectively, which increased to 10.8% and 12.9% in patients with stages III and IV, respectively. These differences in the prevalence of thrombocytosis reached statistical significance (P=0.022). The five-year survival rate in patients with or without thrombocytosis was significantly different (42.6%, 65.9%, respectively; P=0.0123) CONCLUSION: Because patients with thrombocytosis have correlation with advancing stage and a poor prognosis, the platelet count at diagnosis may give additional prognostic information for patients with gastric cancer. Elevated platelet counts are mainly associated with the presence of anemia.
Anemia ; Diagnosis ; Disease Progression ; Humans ; Platelet Count ; Prevalence ; Prognosis ; Serum Albumin ; Stomach Neoplasms* ; Survival Rate ; Thrombocytosis*

The objective of this study was to explore the differences between refractory anemia with ringed sideroblast (RARS) and RARS associated with marked thrombocytosis (RARS-T) in the clinical, biological features and prognosis. The morphological changes of cells were observed by bone marrow smear and biopsy. Immunologic phenotype was analyzed by flow cytometry, and chromosome was examined by conventional chromosomal analysis. JAK2 V617F and MPL W515L mutations were screened by allele-specific polymerase chain reaction (AS-PCR) and sequence analysis. The results showed that this case was clinically diagnosed as RARS with thrombophilia, the level of serum potassium was positively related with platelet counts. When platelets increased, the clusters of atypical giant platelets and megakaryocytes were observed in peripheral blood and bone marrow examined by bone marrow smear and bone marrow biopsy respectively, JAK2 V617F and MPL W515L mutations were negative. It is concluded that RARS may transform into RARS-T accompanied with megakaryocyte proliferation, large atypical platelets and negative JAK2 V617F. Preventing thrombophilia and monitoring relative gene mutations are necessary when atypical giant platelets and fluctuant platelet counts occurred in process of RARS with tendency to RARS-T.
Aged ; Anemia, Refractory ; diagnosis ; metabolism ; pathology ; Anemia, Sideroblastic ; diagnosis ; pathology ; Blood Platelets ; pathology ; Female ; Humans ; Platelet Count ; Thrombocytosis ; pathology

OBJECTIVE: Thrombocytosis is an adverse prognostic factor in many types of cancer. We investigated if pre-treatment increased platelet counts provide prognostic information specifically in patients with stage III and IV serous ovarian cancer which is the most common clinical presentation of ovarian cancer. METHODS: Platelet number on diagnosis of stage III and IV serous ovarian adenocarcinoma was evaluated in 91 patients for whom there were complete follow-up data on progression and survival. Survival and progression free survival of patients with normal platelet counts (150-350 x10(9)/L) was compared with that of patients with thrombocytosis (>350x10(9)/L) by chi2 and logrank tests. RESULTS: The median age of the patients was 66 years-old. From the 91 patients, 52 (57.1%) had normal platelet counts (median, 273x10(9)/L; range, 153-350) at diagnosis of their disease and 39 patients (42.9%) had thrombocytosis (median, 463x10(9)/L; range, 354-631). In the group of patients with normal platelet counts, 24 of the 52 patients had died with a median survival of 43 months (range, 3-100). In the group of patients with thrombocytosis, 24 of the 39 patients had died with a median survival of 23 months (range, 4-79). In the entire group of 91 patients there was a statistically significant difference of the overall survival and progression-free survival between the two groups (logrank test P=0.02 and P=0.007, respectively). CONCLUSION: In this retrospective analysis of stage III and IV ovarian cancer patients, thrombocytosis at the time of diagnosis had prognostic value regarding overall survival and progression-free survival.
Adenocarcinoma ; Blood Platelets ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Ovarian Neoplasms* ; Platelet Count ; Prognosis ; Retrospective Studies ; Thrombocytosis*

BACKGROUND: For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600x10(3)/microliter or more. METHODS: The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis. RESULTS: In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was > or = 820x10(3)/microliter; 80.6% and 80.0%, when the plateletcrit was > or =0.63%; and 64.5% and 99.1%, respectively, when LPLT was > or = 23x10(3)/microliter. CONCLUSIONS: The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased.
Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Platelet Count/*instrumentation/methods ; ROC Curve ; Sensitivity and Specificity ; Thrombocythemia, Essential/*diagnosis ; Thrombocytosis/*diagnosis

BACKGROUND: Differential diagnosis may be difficult between essential thrombocythemia (ET) and chronic myelogenous leukemia (CML) with marked thrombocytosis, mild leukocytosis, and a few immature myeloid cells in peripheral blood at onset. The aim of the present study was to analyze clinical, hematologic, and molecular features of patients with CML, mimicking ET. METHODS: Among patients from Ewha and Gachon Gil Medical Center between January 1990 and June 2001, our study group included 3 patients with Ph-positive CML with marked thrombocy-tosis (>600 X 10(9)/L) and mild leukocytosis (<20 X 10(9)/L) and 12 patients of the typical ET as a con-trol group. RESULTS: Peripheral blood basophilia (4 - 12%) and a few immature granulocytes (1 - 9%) were the characteristic features of CML with thrombocythemic onset, compared with the typical ET. There was no evidence of bone marrow eosinophilia, basophilia, or fibrosis in CML with thrombocythemic onset. CONCLUSIONS: Our study suggests that peripheral basophilia as well as the positivity of Ph chromo-somes or bcr/abl gene rearrangement can be a clue to diagnosis of CML.
Bone Marrow ; Diagnosis ; Diagnosis, Differential ; Eosinophilia ; Fibrosis ; Gene Rearrangement ; Granulocytes ; Humans ; Hydrogen-Ion Concentration ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytosis ; Myeloid Cells ; Thrombocythemia, Essential ; Thrombocytosis

This study was purposed to explore the clinical application of mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR), lactate dehydrogenase (LDH) level in the differential diagnosis of thrombocytosis. The clinical applications of 3 platelet routine laboratory parameters (MPV, PDW, P-LCR) and LDH were examined in 1048 patients with thrombocytosis-related diseases: reactive thrombocytosis (RT), chronic myeloproliferative disease (CMPD) including chronic myeloid leukemia (CML), essential thrombocythemia (ET) and polycythemia vera (PV). Receiver operating characteristic (ROC) curve was used to predict the cause of thrombocytosis. The results indicated that there were significant differences in MCV, PDW, P-LCR and LDH level between RT and CMPD groups (p < 0.05). The area under ROC curve of PDW and P-LCR for prediction of CMPD were 0.96 (95% CI: 0.93 - 0.99) and 0.89 (95% CI: 0.84 - 0.95) respectively, and whose optimal cut-off value was 11.95%and 23.05% respectively. Three types of CMPD were characterized as follows: high P-LCR and high LDH level in chronic myeloid leukemia, whose optimal cut-off value was 424 U/L and 26.10% respectively; slightly high LDH level and high Plt count in ET, the optimal cut-off value of Plt was 939 x 10⁹/L. In conclusion, these characteristics of MPV, PDW, P-LCR and LDH levels may be useful for simple and primary differential diagnosis of the thrombocytosis-related disease mentioned above.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Female ; Humans ; L-Lactate Dehydrogenase ; analysis ; Male ; Middle Aged ; Platelet Count ; Thrombocytosis ; diagnosis ; Young Adult

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by overproduction of myeloid white blood cells. Philadelphia chromosome is an essential finding for CML diagnosis. Generally, a clinical diagnosis of essential thrombocythemia (ET) can be established from isolated marked thrombocytosis in peripheral blood. However, Philadelphia chromosome-positivity or bcr/abl rearrangement with isolated thrombocytosis should be diagnosed as CML, not ET, according to World Health Organization diagnostic criteria. Therefore, CML should not be excluded before confirming the presence of the Philadelphia chromosome or bcr/abl rearrangement in cases of isolated thrombocytosis in peripheral blood. We report a case of CML with clinical features of ET in a patient successfully treated with imatinib.
Bone Marrow* ; Diagnosis ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytes ; Philadelphia Chromosome ; Thrombocythemia, Essential* ; Thrombocytosis ; World Health Organization ; Imatinib Mesylate

BACKGROUND: Essential thrombocythemia (ET) is thought to reflect transformation of a multipotent hematopoietic stem cell, but its molecular pathogenesis remains obscure. But tyrosine kinase, especially Janus kinase 2 (JAK2), has been implicated in myeloproliferative disorders other than chronic myeloid leukemia. We investigated the frequency of JAK2 mutation and its correlation with other clinicopathologic variables in Korean patients with ET and reactive thrombocytosis (RT). METHODS: JAK2 mutation analysis was performed on genomic DNA from bone marrow aspirates of 24 patients with ET and peripheral blood in 36 patients with RT using allele-specific PCR. RESULTS: JAK2 mutation was detected in 11 patients (46%) among the 24 patients with ET and was not found in 36 patients with RT. In patients with ET, older age and leukocytosis were related with JAK2 mutation without statistical significance (P=0.172 and 0.094, respectively). But this mutation was not correlated with sex, hemoglobin, platelet count, splenomegaly, increased cellularity of bone marrow, bone marrow fibrosis and vascular complications. CONCLUSIONS: The current observation strengthens the specific association between JAK2 mutation and ET. At the diagnosis of ET in Korean patients, identification of JAK2 mutation should be incorporated in the basis for new approaches.
Aged ; Alleles ; Amino Acid Substitution ; Blood Platelets/metabolism ; Female ; Humans ; Janus Kinase 2/*genetics ; Korea ; Male ; Middle Aged ; Polymerase Chain Reaction ; Thrombocytosis/blood/*diagnosis/genetics

PURPOSE: It has previously been reported that patients with renal cell carcinomas(RCC) with normal platelet count have an increased survival rate compared with those with thrombocytosis. Whether thrombocytosis was associated with poor prognosis in patients with a renal cell carcinomas was determined. MATERIALS AND METHODS: The record of 161 patients with renal cell carcinomas, who underwent radical nephrectomies, between January 1993 and December 2001, were retrospectively reviewed. The inclusion criteria were at least one perioperative platelet count and a histologic diagnosis of RCC. The survival, pathological tumor stage and grade, histological cell subtype, age, gender, hematuria and history of flank pain were recorded from the charts. Platelet counts were checked, and any patient with at least 1 platelet count greater than 400,000/mm3 was classified with thrombocytosis. RESULTS: Mean patient age and follow-up duration were 56.6, ranging from 30 to 80 years, and 49.8+/-28.8 months, respectively. There were 30 and 131 patients with thrombocytosis and persistently normal platelet counts, respectively. 11 of the 30 patients with thrombocytosis and 7 of the remaining 131 patients died of disease progression. Patients with thrombocytosis had a mean survival of 63.6 months, compared with 115.9 months in those without. The pathological tumor stage, nuclear grade and flank pain were associated with thrombocytosis(p<0.005). However, no statistically significant associations were found between other prognostic factors(cell subtype, gender, age and hematuria) and the presence of thrombocytosis. CONCLUSIONS: Perioperative thrombocytosis was found more frequently in patients with advanced RCC, and those patients showed poorer survival compared with those with a normal platelet count. These results suggest that the perioperative platelet count could be a new prognostic factor in patients with RCC having undergone a radical nephrectomy.
Carcinoma, Renal Cell* ; Diagnosis ; Disease Progression ; Flank Pain ; Follow-Up Studies ; Hematuria ; Humans ; Nephrectomy* ; Platelet Count ; Prognosis ; Retrospective Studies ; Survival Rate ; Thrombocytosis*

Although there have been substantial advances in confirming diagnoses and defining the molecular characteristics of polycythemia vera (PV) and essential thrombocythemia (ET), treatments for these conditions remain elementary. The main goal is still mainly focused on reducing the risk of thrombosis. The prevention of hemorrhage, leukemia transformation, and progression to myelofibrosis has yet to be established. To reduce the risk of thrombosis, risk-adapted treatment is recommended. Phlebotomy is the most important and effective treatment modality for patients with erythrocytosis, while cytoreduction using hydroxyurea, busulfan, or interferon-α is an ancillary treatment for patients at high risk for thrombosis. Anagrelide is used to decrease platelet counts in patients with thrombocytosis by inhibiting the maturation of platelets from megakaryocytes. Recent trials have shown that ruxolitinib, a Janus kinase (JAK) inhibitor, has clinical benefits in patients with polycythemia vera who show an inadequate response, or unacceptable side effects, to therapeutic doses of hydroxyurea. Theoretically, JAK inhibitors may also delay the progression of leukemia transformation and myelofibrosis but there is still no evidence of this. The cost of JAK inhibitors for the treatment of patients with PV/ET is a difficult hurdle for its use as a first-line treatment.
Busulfan ; Diagnosis ; Hemorrhage ; Humans ; Hydroxyurea ; Janus Kinases ; Leukemia ; Megakaryocytes ; Phlebotomy ; Phosphotransferases ; Platelet Count ; Polycythemia Vera* ; Polycythemia* ; Primary Myelofibrosis ; Thrombocythemia, Essential* ; Thrombocytosis ; Thrombosis