Advertisement

Can we use platelet-to-lymphocyte ratio (PLR) to differentiate JAK2-unmutated erythrocytosis from polycythemia vera?

  • Ivan Krečak
    Correspondence
    Corresponding author at: Department of Internal Medicine, General Hospital of Šibenik-Knin County, Stjepana Radića 83, 22000, Šibenik, Croatia.
    Affiliations
    Department of Internal Medicine, General Hospital of Sibenik-Knin County, Sibenik, Croatia

    School of Medicine, University of Rijeka, Rijeka, Croatia
    Search for articles by this author
  • Marko Lucijanić
    Affiliations
    Division of Hematology, University Hospital Dubrava, Zagreb, Croatia

    School of Medicine, University of Zagreb, Zagreb, Croatia
    Search for articles by this author
Published:September 29, 2022DOI:https://doi.org/10.1016/j.ejim.2022.09.023
      with great interest we have read the recent article by Ernest et al. [
      • Ernest V.
      • Abbou N.
      • Tichadou A.
      • Arcani R.
      • Venton G.
      Characteristics of JAK2 unmutated erythrocytosis: distinctive traits between polycythemia vera and non-polycythemia vera patients.
      ] reporting distinctive clinical and laboratory features of patients with Janus Kinase 2 (JAK2)-unmutated erythrocytosis. Considering that discriminating polycythemia vera (PV) patients from JAK2-unmutated patients is of major importance in everyday clinical practice, especially due to different treatment approaches, the study by Ernest et al. [
      • Ernest V.
      • Abbou N.
      • Tichadou A.
      • Arcani R.
      • Venton G.
      Characteristics of JAK2 unmutated erythrocytosis: distinctive traits between polycythemia vera and non-polycythemia vera patients.
      ] provides valuable information for the practicing clinicians. It should be emphasized again that laboratory thresholds required for investigation of PV, a clonal hematopoietic stem cell disorder characterized by an increased thrombotic risk, have been significantly lowered in 2016 by the World Health Organization (WHO) [
      • Arber D.A.
      • Orazi A.
      • Hasserjian R.
      • et al.
      The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.
      ], causing a substantial rise in PV investigations worlwide. In fact, one Canadian study reported that approximately 4% of all male subjects would need PV workup based solely on their hemoglobin and hematocrit values [
      • Busque L.
      • Porwit A.
      • Day R.
      • et al.
      Laboratory investigation of myeloproliferative neoplasms (MPNs):  recommendations of the canadian mpn group.
      ]. In addition, subnormal erythropoietin levels, a minor diagnostic criterion by the WHO, may not be fully reliable, considering that approximately one-third of patients with PV can have erythropoietin levels within the reference range, which is common in obese patients, smokers, or in those with chronic obstructive pulmonary disorder (COPD) [
      • Lupak O.
      • Han X.
      • Xie P.
      • Mahmood S.
      • Mohammed H.
      • Donthireddy V.
      The role of a low erythropoietin level for the polycythemia vera diagnosis.
      ]. This, in turn, may cause an increase in bone marrow examinations which are certainly painful for the patients. In fact, recent reports suggest that 31%–41.5% of JAK2-unmutated patients undergo (often unnecessary) diagnostic bone marrow biopsies [
      • Nguyen E.
      • Harnois M.
      • Busque L.
      • et al.
      Phenotypical differences and thrombosis rates in secondary erythrocytosis versus polycythemia vera.
      ,
      • Krečak I.
      • Holik H.
      • Zekanović I.
      • et al.
      Thrombotic risk in secondary polycythemia resembles low-risk polycythemia vera and increases in specific subsets of patients.
      ]. Finally, red blood cell mass measurement using the radioactive isotopes is considered to be the most accurate diagnostic test for PV [
      • Hasselbalch H.C.
      Time for revival of the red blood cell count and red cell mass in the differential diagnosis between essential thrombocythemia and polycythemia vera?.
      ] but it is expensive, toxic, and unavailable in most countries.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ernest V.
        • Abbou N.
        • Tichadou A.
        • Arcani R.
        • Venton G.
        Characteristics of JAK2 unmutated erythrocytosis: distinctive traits between polycythemia vera and non-polycythemia vera patients.
        Eur J Intern Med. 2022; (S:S0953-6205(22)00319-3)
        • Arber D.A.
        • Orazi A.
        • Hasserjian R.
        • et al.
        The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.
        Blood. 2016; 127: 2391-2405
        • Busque L.
        • Porwit A.
        • Day R.
        • et al.
        Laboratory investigation of myeloproliferative neoplasms (MPNs):  recommendations of the canadian mpn group.
        Am J Clin Pathol. 2016; 146: 408-422
        • Lupak O.
        • Han X.
        • Xie P.
        • Mahmood S.
        • Mohammed H.
        • Donthireddy V.
        The role of a low erythropoietin level for the polycythemia vera diagnosis.
        Blood Cells Mol Dis. 2020; 80102355
        • Nguyen E.
        • Harnois M.
        • Busque L.
        • et al.
        Phenotypical differences and thrombosis rates in secondary erythrocytosis versus polycythemia vera.
        Blood Cancer J. 2021; 11: 75
        • Krečak I.
        • Holik H.
        • Zekanović I.
        • et al.
        Thrombotic risk in secondary polycythemia resembles low-risk polycythemia vera and increases in specific subsets of patients.
        Thromb Res. 2022; 209: 47-50
        • Hasselbalch H.C.
        Time for revival of the red blood cell count and red cell mass in the differential diagnosis between essential thrombocythemia and polycythemia vera?.
        Haematologica. 2019; 104: 2119-2125
        • Wouters H.J.C.M.
        • Mulder R.
        • van Zeventer I.A.
        • Schuringa J.J.
        • van der Klauw M.M.
        • van der Harst P.
        • Diepstra A.
        • Mulder A.B.
        • Huls G.
        Erythrocytosis in the general population: clinical characteristics and association with clonal hematopoiesis.
        Blood Adv. 2020; 4 (9): 6353-6363
        • Krečak I.
        • Holik H.
        • Morić Perić M.
        • et al.
        High platelet-to-lymphocyte ratio may differentiate polycythemia vera from secondary polycythemia.
        Wien Klin Wochenschr. 2022; 134 (202): 483-486
        • Krečak I.
        • Holik H.
        • Morić Perić M.
        • et al.
        Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as prognostic biomarkers in polycythemia vera.
        Int J Lab Hematol. 2022; 44: e145-e148