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Mouse model of congenital polycythemia: Homologous replacement of murine gene by mutant human erythropoietin receptor gene.

Mutations causing truncations of the cytoplasmic domain of the human erythropoietin receptor (EPOR) result in a dominantly inherited disorder-primary familial congenital polycythemia. This disorder is characterized by increased numbers of erythrocytes (polycythemia) and by in vitro hypersensitivity of erythroid precursors to erythropoietin. The consequences of EPOR truncation in nonerythroid tissues are unknown. We replaced the murine EPOR gene with a wild-type human EPOR gene and a mutant human EPOR gene that we initially identified in a patient with polycythemia. This mutation leads to an EPOR truncated after the first tyrosine residue of the intracellular domain. Mice heterozygous for this mutant allele and a wild-type human EPOR allele mimicked the human disorder. Interestingly, mice that were homozygous for the mutant human allele were severely polycythemic but viable. Our results provide a model for functional studies of EPOR-triggered signaling pathways in erythropoiesis. These animals can now be used to investigate the molecular pathophysiology of this gain-of-function EPOR mutation in erythroid tissue and in those nonerythroid tissues that express EPOR.

Animals↗

Polycythemia produced in rats by environmental contaminants.

Polycythemia developed in progeny from mothers who were exposed during pregnancy to a combination of methylmercury chloride plus ethylurea and sodium nitrite. The polycythemia occurred as early as one month of age and as many as 24% of the offspring developed the polycythemic condition. Many features of this condition are similar to those of polycythemia vera in man, such as elevated hematocrits and white and red blood cell counts, splenomegaly, and hyperplasia of bone marrow accompanied by megakaryocytosis.

Animals↗

Polycythemia vera and water-induced pruritus: evidence against mast cell involvement.

The mechanism of water-induced pruritus in patients with polycythemia vera is unknown. Evidence has been presented previously that bathing or showering may trigger mast cell degranulation and that release of a mediator by mast cells may be responsible for the pruritus. Tryptase is a specific marker of human mast cell secretory granules and its presence in body fluids indicates mast cell degranulation. In this study, serum tryptase levels were measured both before and one hour after showering in 11 patients suffering from polycythemia vera and water-induced pruritus. Tryptase was not found in the serum of any of the subjects one hour after showering, when levels would be expected to be near peak had significant mast cell degranulation occurred. These results argue against mass cell degranulation with systemic release of a mast cell product as the mechanism for water-induced pruritus in patients with polycythemia vera.

Aged↗

Crystalloid or colloid for partial exchange transfusion in neonatal polycythemia: a systematic review and meta-analysis.

AIMS: To determine whether crystalloid solutions are as effective as colloid solutions when a partial exchange transfusion is performed in newborns with polycythemia. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register of the Cochrane Library (1966-2004). Keywords used were: polycythemia, partial exchange transfusion, hyperviscosity, and limited to newborn. Randomized studies in newborns with polycythemia were selected for evaluation. Outcomes examined were: long-term neurodevelopment; short-term physiological effects; improvement in clinical symptoms; reduction in haematocrit at 4-6 h; haematocrit at 24 h; and frequency of serious complications. RESULTS: Four randomized controlled clinical trials, including 200 patients in total, with evaluable data, which satisfied our criteria, were found. There were no data on long-term outcomes. There is no reported important difference in short-term physiologic effects. Use of crystalloid was as effective as colloid in both correction of haematological values and reduction of clinical symptoms following partial exchange transfusion. CONCLUSION: Crystalloid solutions are as effective as colloid solutions for partial exchange transfusion. When crystalloid solutions are used for this purpose, there is no risk of transmission of blood-borne diseases, there is no risk of anaphylaxis, they are rapidly and easily available, and are less expensive. The use of crystalloid should become the standard for partial exchange transfusion.

Colloids↗

Polycythemia associated with myeloma.

Four cases of polycythemia associated with myeloma are described. Three of four had polycythemia vera with IgA monoclonal gammopathy. The possible relationship between chronic myeloproliferative disorder and myeloma is discussed. Review of the literature revealed 11 such cases, four of which had a history of 32P therapy for polycythemia vera.

Adult↗

Splenic hematopoiesis in polycythemia vera. A morphologic and immunohistologic study.

Spleens from 42 patients with polycythemia vera were studied with immunohistologic technics to assess the degree of hematopoietic cellularity in an attempt to clarify the pathogenesis of the splenomegaly characteristic of this disorder. The 22 spleens obtained in the erythrocytotic phase showed striking congestion with mature erythrocytes but no significant extramedullary hematopoiesis. However, the 20 spleens obtained in the spent phase showed prominent trilinear extramedullary hematopoiesis. Increasing splenomegaly with extramedullary hematopoiesis correlated with the development of increased medullary reticulin and peripheral blood leukoerythroblastosis. Splenic myeloid metaplasia is not a feature of uncomplicated polycythemia vera, and its presence indicates progression to the spent phase, or postpolycythemic myeloid metaplasia. The authors' findings indicate that the presence of hematopoietic precursors in the spleen in the spent phase of polycythemia vera and in agnogenic myeloid metaplasia is a result of their filtration from the peripheral blood.

Adult↗

Hemostatic gene polymorphisms and the prevalence of thrombotic complications in polycythemia vera and essential thrombocythemia.

Patients with polycythemia vera and essential thrombocythemia are at risk for thrombotic and bleeding complications. Currently, no diagnostic test can predict thrombohemorrhagic complications. In a prospective study of 86 patients with polycythemia vera (43 patients) or essential thrombocythemia (43 patients), we examined the possible role of polymorphisms of platelet adhesion receptors [glycoprotein (GP) Ibalpha, GPIa, GPIIIa) and clotting factor II (prothrombin's G20210A mutation) and clotting factor V (Leiden mutation) in determining the risk of thrombotic or bleeding complications. Except for an association between vasomotor symptoms and prothrombin mutation (P < 0.001), no significant correlation between polymorphism of clotting factors and thrombohemorrhagic complications was identified. When the entire patient cohort was considered, the polymorphisms of platelet adhesion receptors were not associated with the risk for thrombotic or bleeding complications. However, among patients with polycythemia vera, the presence of the PlA2 allele of GPIIIa was associated with an increased risk of arterial thrombosis. In view of previous studies linking the presence of the PlA2 allele of GPIIIa to a higher risk for coronary artery thrombosis, our data have physiologic relevance. However, they need to be confirmed in a larger study.

Adult↗

Cholelithiasis in an infant with polycythemia.

An 11-week-old infant with polycythemia presented with cholestasis secondary to cholelithiasis. It is likely that hemolysis secondary to polycythemia predisposed our patient to cholelithiasis. We suggest that polycythemia may be a new cause of cholelithiasis in infancy.

Cholelithiasis↗

Polycythemia decreases fatigue in tetanic contractions of canine skeletal muscle.

PURPOSE: The effects of an acute polycythemia on muscle fatigue development were investigated in the self-perfused canine gastrocnemius in situ. METHODS: Following isolation of the gastrocnemius, dogs (N = 5) were made polycythemic through a bolus injection of packed erythrocytes (hematocrit (Hct) = 90-92%) to raise systemic Hct to 63.5 +/- 0.5%. Subsequently, the gastrocnemius was stimulated, through the sciatic nerve, to perform 20 min of isotonic tetanic contractions (60 x min(-1), 200 ms, 50Hz). Control (normocythemic) animals (N = 5) underwent an identical contraction regimen. RESULTS: Although blood flow to the gastrocnemius was not different at any time, oxygen delivery was significantly increased during polycythemia (peak = 33.7 +/- 2.2 mL x 100 g(-1) x min-1) over control (peak = 25.1 +/- 2.1 mL x 100 g(-1)x min(-1)) at all times during contraction. Oxygen uptake by the gastrocnemius, although consistently increased, was not significantly different between the normocythemic and polycythemic conditions at any time. The rate of fatigue was significantly decreased over the first 6 min of contraction in polycythemic animals (3.5 +/- 0.6% x min(-1)) when compared with controls (5.8 +/- 0.7% x min(-1)). Subsequent fatigue development was not different between groups. As a result of the early rate differences in fatigue, however, the work production in polycythemic animals was significantly greater than in normocythemic dogs for the duration of the contraction period. CONCLUSION: We conclude that during high metabolic rate isotonic tetanic contractions, muscle fatigue development is diminished by polycythemia, but the ergogenic effect appears to be transient.

Analysis of Variance↗

Neonatal polycythemia in infants of insulin-dependent diabetic mothers.

The rate of neonatal polycythemia was determined prospectively in 34 infants of diabetic mothers pair-matched to 34 infants of nondiabetic mothers (control group) for site of sampling, time of sampling, time of cord clamping, gestational age, mode of delivery, and one- and five-minute Apgar scores. Polycythemia (venous hematocrit greater than or equal to 65%) was present in 29.4% of infants of diabetic mothers and 5.9% of control subjects (P less than .03). Mean nucleated red blood cell counts were significantly higher in infants of diabetic mothers than in controls. Polycythemia did not correlate with higher maternal hemoglobin A1 concentration or with increased infant weight percentile, but did correlate with neonatal hypoglycemia. The authors speculate that increased erythropoiesis exists in infants of diabetic mothers and might be subsequent to fetal hypoxemia due to fetal hyperglycemia, hyperinsulinism, and hyperketonemia.

Birth Weight↗

Apoptosis and polycythemia vera.

Polycythemia vera is an acquired clonal myeloproliferative disorder characterized by increased numbers of erythroid cells, often with a concomitant rise in neutrophils and/or megakaryocytes. Normally, erythropoietin is essential for the survival and proliferation of erythroid progenitors; however in polycythemia vera the erythroid progenitor cells can survive and develop in the absence of erythropoietin. Members of the Bcl-2 family of apoptosis regulators have been shown to mediate the erythropoietin-dependent survival of erythroid cells. In this article, recent advances in understanding the mechanisms used by erythroid progenitors from patients with polycythemia vera to control apoptosis, are discussed.

Animals↗

Platelet transfusion for surgery in the presence of polycythemia vera.

Surgery in the presence of uncontrolled polycythemia vera is associated with a high incidence of perioperative hemorrhage and postoperative venous thromboses. Control prior to surgery reduces the frequency of perioperative complications. A 73-year-old women suffering from polycythemia vera was scheduled for subtotal gastrectomy. Her platelet count before surgery was slightly elevated but bleeding time was prolonged. To manage the current case of polycythemia vera, hydroxyurea was effective for the control of hematocrit and transfusion of platelet concentrates was effective for hemostasis.

Aged↗

Effect of L-dopa on polycythemia.

A patient with Parkinson's disease, in whom polycythemia vera was known to be present for several years prior to the onset of parkinsonian symptoms, received treatment with a preparation consisting of L-dopa plus a decarboxylase inhibitor (Madopar). Improvement in the parkinsonian symptoms was associated with marked improvement in the polycythemia. A therapeutic trial of the same L-dopa preparation in 2 other patients with polycythemia had similar effects. The cases are presented and the possible central therapeutic effect of L-dopa is discussed.

Aged↗

Effect of polycythemia on vascular volume in the newborn dog.

The effect of polycythemia [hematocrit (Hct) 64-80] on blood volume (BV) was studied in 27 unanesthetized, splenectomized newborn dogs (age 6-14 days, postsplenectomy 5-13 days). Normovolemic polycythemia (N) was induced in nine pups by exchange transfusion with 75 ml/kg of adult, packed (to Hct 95) red blood cells (RBC). Hypervolemic polycythemia (H) was induced in 11 pups by transfusion of RBC (50 ml/kg). Seven pups received exchange transfusion with 75 ml/kg of whole blood and served as controls (C). Red cell volume (RCV, 51CrRBC) and plasma volume (PV, 125I-fibrinogen and Evans blue) were measured prior to and at 1, 2, and 4 h after transfusion, before the pups received fluid orally. The pups were fed 8 ml X kg-1 X h-1 after 4 h, and measurements were repeated at 8 and 24 h. BV fell in C prior to 4 h by 10 +/- 4% (SD) (P less than 0.01) and then rose to initial levels. BV rose in the N pups by 17 +/- 9 (P less than 0.01), 14 +/- 5 (P less than 0.01), 9 +/- 10 (P less than 0.1), 17 +/- 9 (P less than 0.01), and 31 +/- 17% (P less than 0.01) at 1, 2, 4, 8, and 24 h post transfusion. BV rose in the H pups by 41 +/- 8, 35 +/- 10, 23 +/- 11, 27 +/- 6, and 43 +/- 9% (all P less than 0.01). Thus newborn dogs with induced N or H equilibrate rapidly to a BV significantly higher than C levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Polycythemia and hydration: effects on thermoregulation and blood volume during exercise-heat stress.

We studied the effects of autologous erythrocyte infusion on thermoregulation and blood volume during exercise in the heat. Specifically, we wanted to determine whether heat-acclimated subjects, as well as hypohydrated subjects, would have a thermoregulatory advantage from acute polycythemia during exercise in the heat. Five heat-acclimated males attempted four heat stress tests (HSTs): two pre- and two postinfusion. Autologous erythrocyte infusion was accomplished with 500 ml of a NaCl-glucose-phosphate solution containing approximately 60% hematocrit. One HST, both pre- and postinfusion, was done while subjects were euhydrated, and one HST was done while subjects were hypohydrated (-5% of body wt). After 30 min of rest in a 20 degrees C antechamber, the HST consisted of a 120-min exposure (2 repeats of 15 min rest and 45 min walking) in a hot (35 degrees C, 45% relative humidity) environment. The findings concerning acute polycythemia in heat-acclimated subjects are summarized: 1) polycythemia increased (P less than 0.05) sweating rate and reduced (P less than 0.01) core temperature during exercise-heat stress for both euhydrated and hypohydrated subjects; 2) the erythrocyte infusion caused an increased (P less than 0.05) plasma volume and increased (P less than 0.01) blood volume; 3) the increased plasma volume was associated with an increased (P less than 0.05) total circulating protein mass; 4) the increased total circulating protein mass tended to better maintain plasma volume when hypohydrated; and 5) heat acclimation may increase extravascular protein mass. Therefore, it is concluded that erythrocyte infusion provides a thermoregulatory advantage during exercise in the heat for heat acclimated subjects when both euhydrated and hypohydrated.

Acclimatization↗

Influence of polycythemia on blood volume and thermoregulation during exercise-heat stress.

We studied the effects of autologous erythrocyte infusion on blood volume and thermoregulation during exercise in the heat. By use of a double-blind design, nine unacclimated male subjects were infused with either 600 ml of a NaCl-glucose-phosphate solution containing a approximately 50% hematocrit (n = 6, reinfusion) or 600 ml of this solution only (n = 3, saline). A heat stress test (HST) was attempted approximately 2-wk pre- and 48-h postinfusion during the late spring months. After 30 min of rest in a 20 degrees C antechamber, the HST consisted of a 120-min exposure (2 repeats of 15 min rest and 45 min treadmill walking) in a hot (35 degrees C, 45% rh) environment while euhydrated. Erythrocyte volume (RCV, 51Cr) and plasma volume (PV, 125I) were measured 24 h before each HST, and maximal O2 uptake (VO2max) was measured 24 h after each HST. Generally, no significant effects were found for the saline group. For the reinfusion group, RCV (11%, P less than 0.01) and VO2max (11%, P less than 0.05) increased after infusion, and the following observations were made: 1) the increased RCV was associated with a reduction in PV to maintain the same blood volume as during the preinfusion measurements; 2) polycythemia reduced total circulating protein but did not alter F-cell ratio, plasma osmolality, plasma protein content, or plasma lactate at rest or during exercise-heat stress; 3) polycythemia did not change the volume of fluid entering the intravascular space from rest to exercise-heat stress; and 4) polycythemia tended to reduce the rate of heat storage during exercise-heat stress.

Blood Proteins↗

Polycythemia after kidney transplantation: influence of the native kidneys on the production of hemoglobin.

3 patients with renal transplantation who developed polycythemia presented normalization of the hemoglobin levels immediately after nephrectomy of the native kidneys. This observation induced the authors to study the role of the native kidneys in the genesis of polycythemia in recipients of renal allografts. Comparison was made among 32 patients submitted to renal transplantation, with maintenance of native kidneys (group I) and among 31 under the same conditions, but without the native kidneys (group II). Both groups were comparable according to age, sex, rejection crisis incidence and immunosuppressive therapy. It was observed that the hemoglobin levels of group I were significantly higher (p less than 0.05 to p less than 0.005) than those observed in group II, from the 3rd to the 30th posttransplantation month, becoming comparable from the 36th to the 54th months. The hemoglobin production, measured by the kinetics of labeled iron (59Fe), was higher in patients of group I. The authors concluded that the native kidneys are responsible for the observed polycythemia after a kidney transplantation.

Adult↗

Simultaneous occurrence of polycythemia vera and Waldenstrom macroglobulinemia: a case report and review of the literature.

Polycythemia vera and lymphoproliferative disorders can occur simultaneously. Lymphoproliferative disorders reported to occur simultaneously with polycythemia vera include chronic lymphocytic leukemia (CLL), non-Hodgkin's lymphoma (NHL), and acute lymphoblastic leukemia (ALL). Different theories have attempted to explain this occurrence. Some implicate a common cell of origin to the two disorders, others include chance alone, yet others implicate an underlying humoral or immune mechanism caused by the first disorder leading to a second clonal expansion. We report the first case of polycythemia vera with a simultaneous diagnosis of Waldenstrom macroglobulinemia, and we review the literature trying to explain this unusual occurrence.

Aged↗