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Erschienen in: Wiener klinische Wochenschrift 3-4/2022

04.11.2021 | original article

Hematocrit to hemoglobin ratio as a prognostic marker in polycythemia vera

verfasst von: Ivan Krečak, MD, PhD, Marko Lucijanić, Ivan Zekanović, Hrvoje Holik, Martina Morić Perić, Marijana Šupe, Božena Coha, Velka Gverić-Krečak

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 3-4/2022

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Summary

Background

The hematocrit to hemoglobin ratio (HHR) is frequently used in everyday practice to measure hemoconcentration; however, clinical associations of HHR in the context of polycythemia vera (PV) have not been investigated so far.

Patients and methods

We retrospectively assessed HHR at the time of diagnosis in 107 PV and 40 secondary polycythemia (SP) patients from three community hospitals.

Results

Median HHR was higher in PV than in SP patients (3.131 vs. 2.975, p = 0.041). Among PV patients, higher HHR correlated with splenomegaly, higher total leukocyte and absolute granulocyte counts, higher red blood cell counts, lower hemoglobin, higher red blood cell distribution width, lower mean corpuscular hemoglobin and lower ferritin levels, whereas in SP patients higher HHR correlated with older age, female sex and lower hemoglobin (p < 0.050 for all analyses). Using the receiver operating curve analysis-defined cut-off points, higher HHR in PV was associated with a shorter time to thrombosis (hazard ratio—HR 5.20, p = 0.022) independently of high-risk disease status (HR 4.48, p = 0.034) and shorter overall survival (HR 6.69, p = 0.009) independently of leukocytosis (HR 4.48, P = 0.034) and the absence of aspirin use (HR 15.53, p < 0.001).

Conclusion

Higher HHR may represent iron deficiency and a stronger clonal myeloproliferation in PV and could provide additional prognostic information to the classical risk assessment.
Literatur
1.
Zurück zum Zitat Wouters HJCM, Mulder R, van Zeventer IA, Schuringa JJ, van der Klauw MM, van der Harst P, et al. Erythrocytosis in the general population: clinical characteristics and association with clonal hematopoiesis. Blood Adv. 2020;4(24):6353–63.CrossRef Wouters HJCM, Mulder R, van Zeventer IA, Schuringa JJ, van der Klauw MM, van der Harst P, et al. Erythrocytosis in the general population: clinical characteristics and association with clonal hematopoiesis. Blood Adv. 2020;4(24):6353–63.CrossRef
2.
Zurück zum Zitat Nguyen E, Harnois M, Busque L, Sirhan S, Assouline S, Chamaki I, et al. Phenotypical differences and thrombosis rates in secondary erythrocytosis versus polycythemia vera. Blood Cancer J. 2021;11(4):75.CrossRef Nguyen E, Harnois M, Busque L, Sirhan S, Assouline S, Chamaki I, et al. Phenotypical differences and thrombosis rates in secondary erythrocytosis versus polycythemia vera. Blood Cancer J. 2021;11(4):75.CrossRef
3.
Zurück zum Zitat Holik H, Krečak I, Gverić-Krečak V, Vučinić Ljubičić I, Coha B. Higher red blood cell distribution width might differentiate primary from secondary polycythemia: a pilot study. Int J Lab Hematol. 2021;43(2):e68–e71.CrossRef Holik H, Krečak I, Gverić-Krečak V, Vučinić Ljubičić I, Coha B. Higher red blood cell distribution width might differentiate primary from secondary polycythemia: a pilot study. Int J Lab Hematol. 2021;43(2):e68–e71.CrossRef
4.
Zurück zum Zitat Bhatt VR. Secondary polycythemia and the risk of venous thromboembolism. J Clin Med Res. 2014;6(5):395–7.PubMedPubMedCentral Bhatt VR. Secondary polycythemia and the risk of venous thromboembolism. J Clin Med Res. 2014;6(5):395–7.PubMedPubMedCentral
5.
Zurück zum Zitat Barbui T, Thiele J, Gisslinger H, Finazzi G, Carobbio A, Rumi E, et al. Masked polycythemia vera (mPV): results of an international study. Am J Hematol. 2014;89(1):52–4.CrossRef Barbui T, Thiele J, Gisslinger H, Finazzi G, Carobbio A, Rumi E, et al. Masked polycythemia vera (mPV): results of an international study. Am J Hematol. 2014;89(1):52–4.CrossRef
6.
Zurück zum Zitat Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391–405.CrossRef Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016;127(20):2391–405.CrossRef
7.
Zurück zum Zitat Busque L, Porwit A, Day R, Olney HJ, Leber B, Éthier V, et al. Laboratory investigation of myeloproliferative neoplasms (MPNs): recommendations of the Canadian MPN group. Am J Clin Pathol. 2016;146(4):408–22.CrossRef Busque L, Porwit A, Day R, Olney HJ, Leber B, Éthier V, et al. Laboratory investigation of myeloproliferative neoplasms (MPNs): recommendations of the Canadian MPN group. Am J Clin Pathol. 2016;146(4):408–22.CrossRef
8.
Zurück zum Zitat McMullin MF, Harrison CN, Ali S, Cargo C, Chen F, Ewing J, et al. A guideline for the diagnosis and management of polycythaemia vera. A British Society for Haematology guideline. Br J Haematol. 2019;184(2):176–91.CrossRef McMullin MF, Harrison CN, Ali S, Cargo C, Chen F, Ewing J, et al. A guideline for the diagnosis and management of polycythaemia vera. A British Society for Haematology guideline. Br J Haematol. 2019;184(2):176–91.CrossRef
9.
Zurück zum Zitat Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368(1):22–33.CrossRef Marchioli R, Finazzi G, Specchia G, Cacciola R, Cavazzina R, Cilloni D, et al. Cardiovascular events and intensity of treatment in polycythemia vera. N Engl J Med. 2013;368(1):22–33.CrossRef
10.
Zurück zum Zitat Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004;350(2):114–24.CrossRef Landolfi R, Marchioli R, Kutti J, Gisslinger H, Tognoni G, Patrono C, et al. Efficacy and safety of low-dose aspirin in polycythemia vera. N Engl J Med. 2004;350(2):114–24.CrossRef
11.
Zurück zum Zitat Landolfi R, Di Gennaro L, Barbui T, De Stefano V, Finazzi G, Marfisi R, et al. Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera. Blood. 2007;109(6):2446–52.CrossRef Landolfi R, Di Gennaro L, Barbui T, De Stefano V, Finazzi G, Marfisi R, et al. Leukocytosis as a major thrombotic risk factor in patients with polycythemia vera. Blood. 2007;109(6):2446–52.CrossRef
12.
Zurück zum Zitat Carobbio A, Ferrari A, Masciulli A, Ghirardi A, Barosi G, Barbui T. Leukocytosis and thrombosis in essential thrombocythemia and polycythemia vera: a systematic review and meta-analysis. Blood Adv. 2019;3(11):1729–37.CrossRef Carobbio A, Ferrari A, Masciulli A, Ghirardi A, Barosi G, Barbui T. Leukocytosis and thrombosis in essential thrombocythemia and polycythemia vera: a systematic review and meta-analysis. Blood Adv. 2019;3(11):1729–37.CrossRef
13.
Zurück zum Zitat Ronner L, Podoltsev N, Gotlib J, Heaney ML, Kuykendall AT, O’Connell C, et al. Persistent leukocytosis in polycythemia vera is associated with disease evolution but not thrombosis. Blood. 2020;135(19):1696–703.CrossRef Ronner L, Podoltsev N, Gotlib J, Heaney ML, Kuykendall AT, O’Connell C, et al. Persistent leukocytosis in polycythemia vera is associated with disease evolution but not thrombosis. Blood. 2020;135(19):1696–703.CrossRef
14.
Zurück zum Zitat Hayuanta HH. Can hemoglobin-hematocrit relationship be used to assess hydration status? Cermin Dunia Kedokteran. 2016;43:139–42. Hayuanta HH. Can hemoglobin-hematocrit relationship be used to assess hydration status? Cermin Dunia Kedokteran. 2016;43:139–42.
15.
Zurück zum Zitat Quintó L, Aponte JJ, Menéndez C, Sacarlal J, Aide P, Espasa M, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Trop Med Int Health. 2006;11(8):1295–302.CrossRef Quintó L, Aponte JJ, Menéndez C, Sacarlal J, Aide P, Espasa M, et al. Relationship between haemoglobin and haematocrit in the definition of anaemia. Trop Med Int Health. 2006;11(8):1295–302.CrossRef
16.
Zurück zum Zitat Insiripong S, Supattarobol T, Jetsrisuparb A. Comparison of hematocrit/hemoglobin ratios in subjects with alpha-thalassemia, with subjects having chronic kidney disease and normal subjects. Southeast Asian J Trop Med Public Health. 2013;44(4):707–11.PubMed Insiripong S, Supattarobol T, Jetsrisuparb A. Comparison of hematocrit/hemoglobin ratios in subjects with alpha-thalassemia, with subjects having chronic kidney disease and normal subjects. Southeast Asian J Trop Med Public Health. 2013;44(4):707–11.PubMed
17.
Zurück zum Zitat Verstovsek S, Harrison CN, Kiladjian JJ, Miller C, Naim AB, Paranagama DC, et al. Markers of iron deficiency in patients with polycythemia vera receiving ruxolitinib or best available therapy. Leuk Res. 2017;56:52–9.CrossRef Verstovsek S, Harrison CN, Kiladjian JJ, Miller C, Naim AB, Paranagama DC, et al. Markers of iron deficiency in patients with polycythemia vera receiving ruxolitinib or best available therapy. Leuk Res. 2017;56:52–9.CrossRef
18.
Zurück zum Zitat Ginzburg YZ, Feola M, Zimran E, Varkonyi J, Ganz T, Hoffman R. Dysregulated iron metabolism in polycythemia vera: etiology and consequences. Leukemia. 2018;32(10):2105–16.CrossRef Ginzburg YZ, Feola M, Zimran E, Varkonyi J, Ganz T, Hoffman R. Dysregulated iron metabolism in polycythemia vera: etiology and consequences. Leukemia. 2018;32(10):2105–16.CrossRef
19.
Zurück zum Zitat Baxter EJ, Scott LM, Campbell PJ, East C, Fourouclas N, Swanton S, et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005;365(9464):1054–61.CrossRef Baxter EJ, Scott LM, Campbell PJ, East C, Fourouclas N, Swanton S, et al. Acquired mutation of the tyrosine kinase JAK2 in human myeloproliferative disorders. Lancet. 2005;365(9464):1054–61.CrossRef
20.
Zurück zum Zitat Kellner Á, Kellner V, Rajnics P, Karádi É, Illés Á, Demeter J, et al. Low mean cell haemoglobin is a valuable parameter of thrombotic risk stratification in patients with polycythemia vera. J Blood Lymph. 2018;8:1.CrossRef Kellner Á, Kellner V, Rajnics P, Karádi É, Illés Á, Demeter J, et al. Low mean cell haemoglobin is a valuable parameter of thrombotic risk stratification in patients with polycythemia vera. J Blood Lymph. 2018;8:1.CrossRef
21.
Zurück zum Zitat Spivak JL. Polycythemia vera: myths, mechanisms, and management. Blood. 2002;100(13):4272–90.CrossRef Spivak JL. Polycythemia vera: myths, mechanisms, and management. Blood. 2002;100(13):4272–90.CrossRef
22.
Zurück zum Zitat Sirhan S, Fairbanks VF, Tefferi A. Red cell mass and plasma volume measurements in polycythemia: evaluation of performance and practical utility. Cancer. 2005;104(1):213–5.CrossRef Sirhan S, Fairbanks VF, Tefferi A. Red cell mass and plasma volume measurements in polycythemia: evaluation of performance and practical utility. Cancer. 2005;104(1):213–5.CrossRef
23.
Zurück zum Zitat Accurso V, Santoro M, Raso S, Contrino AD, Casimiro P, Piazza FD, et al. Splenomegaly impacts prognosis in essential thrombocythemia and polycythemia vera: a single center study. Hematol Rep. 2019;11(4):8281.CrossRef Accurso V, Santoro M, Raso S, Contrino AD, Casimiro P, Piazza FD, et al. Splenomegaly impacts prognosis in essential thrombocythemia and polycythemia vera: a single center study. Hematol Rep. 2019;11(4):8281.CrossRef
24.
Zurück zum Zitat Zöller B, Melander O, Svensson P, Engström G. Red cell distribution width and risk for venous thromboembolism: a population-based cohort study. Thromb Res. 2014;133(3):334–9.CrossRef Zöller B, Melander O, Svensson P, Engström G. Red cell distribution width and risk for venous thromboembolism: a population-based cohort study. Thromb Res. 2014;133(3):334–9.CrossRef
25.
Zurück zum Zitat Bucciarelli P, Maino A, Felicetta I, Abbattista M, Passamonti SM, Artoni A, et al. Association between red cell distribution width and risk of venous thromboembolism. Thromb Res. 2015;136(3):590–4.CrossRef Bucciarelli P, Maino A, Felicetta I, Abbattista M, Passamonti SM, Artoni A, et al. Association between red cell distribution width and risk of venous thromboembolism. Thromb Res. 2015;136(3):590–4.CrossRef
26.
Zurück zum Zitat Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis. 2015;7(10):E402–E11.PubMedPubMedCentral Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis. 2015;7(10):E402–E11.PubMedPubMedCentral
27.
Zurück zum Zitat Krečak I, Krečak F, Gverić-Krečak V. High red blood cell distribution width might predict thrombosis in essential thrombocythemia and polycythemia vera. Blood Cells Mol Dis. 2020;80:102368.CrossRef Krečak I, Krečak F, Gverić-Krečak V. High red blood cell distribution width might predict thrombosis in essential thrombocythemia and polycythemia vera. Blood Cells Mol Dis. 2020;80:102368.CrossRef
28.
Zurück zum Zitat Lucijanic M, Pejsa V, Jaksic O, Mitrovic Z, Tomasovic-Loncaric C, Stoos-Veic T, et al. The degree of anisocytosis predicts survival in patients with primary myelofibrosis. Acta Haematol. 2016;136(2):98–100.CrossRef Lucijanic M, Pejsa V, Jaksic O, Mitrovic Z, Tomasovic-Loncaric C, Stoos-Veic T, et al. The degree of anisocytosis predicts survival in patients with primary myelofibrosis. Acta Haematol. 2016;136(2):98–100.CrossRef
29.
Zurück zum Zitat Verstovsek S, De Stefano V, Heidel FH, Zuurman M, Zaiac M, Bigan E, et al. US Optum database study in polycythemia vera patients: thromboembolic events (TEs) with hydroxyurea (HU) vs ruxolitinib switch therapy and machine-learning model to predict incidence of TEs and HU failure. Blood. 2019;134(Supplement_1):1659.CrossRef Verstovsek S, De Stefano V, Heidel FH, Zuurman M, Zaiac M, Bigan E, et al. US Optum database study in polycythemia vera patients: thromboembolic events (TEs) with hydroxyurea (HU) vs ruxolitinib switch therapy and machine-learning model to predict incidence of TEs and HU failure. Blood. 2019;134(Supplement_1):1659.CrossRef
Metadaten
Titel
Hematocrit to hemoglobin ratio as a prognostic marker in polycythemia vera
verfasst von
Ivan Krečak, MD, PhD
Marko Lucijanić
Ivan Zekanović
Hrvoje Holik
Martina Morić Perić
Marijana Šupe
Božena Coha
Velka Gverić-Krečak
Publikationsdatum
04.11.2021
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 3-4/2022
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-021-01967-z

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