Blood Res.  2021 Sep;56(3):166-174. 10.5045/br.2021.2021111.

Causes of erythrocytosis and its impact as a risk factor for thrombosis according to etiology: experience in a referral center in Mexico City

• Olivas-Martinez A
• Corona-Rodarte E
• Nuñez-Zuno A
• Barrales-Benítez O
• Montante-Montes de Oca D
• Delgado-de la Mora J
• León-Aguilar D
• Hernández-Juárez HE
• Tuna-Aguilar E

• KMID: 2520610
• DOI: http://doi.org/10.5045/br.2021.2021111

Abstract

Background
Thrombotic events are well documented in primary erythrocytosis, but it is uncertain if secondary etiologies increase the risk of thrombosis. This study aimed to determine the causes of erythrocytosis and to identify its impact as a risk factor for thrombosis.
Methods
Data were obtained from patients with erythrocytosis between 2000 and 2017 at a referral hospital in Mexico City. Erythrocytosis was defined according to the 2016 WHO classification. Time to thrombosis, major bleeding, or death were compared among groups of patients defined by the etiology of erythrocytosis using a Cox regression model, adjusting for cardiovascular risk factors.
Results
In total, 330 patients with erythrocytosis were studied. The main etiologies of erythrocytosis were obstructive sleep apnea (OSA) in 29%, polycythemia vera (PV) in 18%, and chronic lung disease (CLD) in 9.4% of the patients. The incidence rate of thrombosis was significantly higher in patients with PV and CLD than that in patients with OSA (incidence rates of 4.51 and 6.24 vs. 1.46 cases per 100 person-years, P =0.009), as well as the mortality rate (mortality rates of 2.72 and 2.43 vs. 0.17 cases per 100 person-years, P =0.003).
Conclusion
The risk of thrombosis in CLD with erythrocytosis was comparable to that in patients with PV. Further larger-scale studies are needed to confirm these findings and evaluate the benefits of preventive management of COPD with erythrocytosis similar to PV.

Keyword

Polycythemia vera; Secondary erythrocytosis; Thrombosis; Phlebotomy

Figure

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  Fig. 1 Thrombosis free survival by final diagnosis.

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  Fig. 2 Major bleeding free survival by final diagnosis.

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  Fig. 3 Overall survival by final diagnosis.

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