Hemorrhagic and thrombotic complications in patients with myeloproliferative diseases

Abstract

OBJECTIVE: To correlate the incidence of hemorrhage and thrombosis to bleeding time (BT) and platelet aggregation in 27 consecutive patients with myeloproliferative diseases (MPD). DESIGN: Retrospective study. SETTING: Public tertiary referral center. PATIENTS: Eighteen patients with chronic myelogenous leukemia (CML), 5 with polycytemia vera (PV), 2 with essential thrombocytemia (ET) and 2 with idiopathic myelofibrosis (MF). Duke's BT and epinephrine-induced platelet aggregation were performed on the patients and on 10 healthy individuals. RESULTS: Eleven patients presented symptoms (41 %): 9 with hemorrhage (33%) and 5 with thrombosis (19%).There were less symptomatic patients in the CML group (28%) than in the other MPD (67%), without statistical significance (Fisher, p=0.06). Duke's BT was longer in symptomatic patients (Mann-Whitney, p<0.05). Platelet aggregation was abnormal in 7 patients (26%) and 71% of them were symptomatic (Fisher, p = 0.07). CONCLUSIONS: The high incidence of bleeding and thrombosis in patients with MPD was related to prolonged BT, but not to platelet aggregation abnormalities.

OBJETIVOS: Relacionar a incidência de sintomas trombo-hemorrágicos com tempo de sangramento (TS) e agregação plaquetária em pacientes com doenças mieloproliferativas crônicas (DMP). DESENHO: Estudo retrospectivo. LOCAL: Hospital público terciário - UNIFESP-EPM. Participantes: Vinte e sete pacientes ambulatoriais, consecutivos, com DMP. Estudado TS de Duke e agregação plaquetária induzida pela adrenalina, comparando a 10 indivíduos saudáveis. MENSURAÇÃO: Análise estatística, com nível de significância menor ou igual a 5% (p<= 0.05). RESULTADOS: Onze pacientes sintomáticos (41 %) : 9 com hemorragia (33%) e 5 com trombose (19%). Os pacientes com leucemia mielóide crônica apresentaram menos sintomas (28%) que os portadores de outras DMP (67%), sem significância estatística (Fisher, p=0,06). 0 TS de Duke foi maior em pacientes sintomáticos (Mann-Whitney, p<0,05). Agregação plaquetária anormal em 7 pacientes (26%), sendo 71% sintomáticos (Fisher, p=0.07). CONCLUSÕES: A incidência de hemorragia ou trombose nos pacientes com DMP foi relacionada com TS prolongado mas não com alterações na agregação plaquetária.