Transcranial Doppler Findings in Myeloproliferative Diseases (Polycythemia Vera and Essential Thrombocytosis): A Systematic Review
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Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

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doi
open access

Published: 17 March 2024

Transcranial Doppler Findings in Myeloproliferative Diseases (Polycythemia Vera and Essential Thrombocytosis): A Systematic Review

Jeanie Allen Marie Beltran, Laurence Kristoffer J. Batino, Mark Timothy T. Cinco, Jose C. Navarro

Jose R. Reyes Memorial Medical Center, Philippines

journal of social and political sciences
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doi

10.31014/aior.1994.07.01.310

Pages: 95-105

Keywords: Transcranial Doppler, Cerebral Hemodynamics, Microembolic Signals, Polycythemia Vera, Essential Thrombocytosis

Abstract

Background and aims: Myeloproliferative neoplasms (MPN) are rare hematologic diseases that require early diagnosis to prevent thrombotic events. Only a few studies have investigated transcranial Doppler (TCD) ultrasonography among these population groups. Following the PRISMA Guidelines, we reviewed the utility of TCD in Polycythemia vera (PV) and Essential Thrombocytosis (ET) patients in the context of cerebral blood flow and detection of microembolic signals (MES). Methods: This systematic review focuses on the application of TCD in MPN. By incorporating findings from one observational study, one prospective study, and three case reports, the review establishes that while TCD is not a primary tool for diagnosing PV and ET, it plays a crucial role in monitoring cerebrovascular complications, assessing thrombotic risk, evaluating treatment responses, and facilitating research related to these conditions. Results: This review incorporates findings from a total of 63 patients. 3.2% had ischemic stroke and 1.6% had transient ischemic attack with a total of 4.8% stroke risk. High-intensity transient signals (HITS) were common in 22% of patients wherein they had elevated hemoglobin, hematocrit, and platelet values. Following treatment and normalization of blood panels, 31.7% had improved cerebral perfusion with normal flow velocities. 3.2% had elevated flow velocities linked to blood flow obstruction. There was significant clinical improvement among the study population, with 17.5% becoming asymptomatic with the disappearance of MES. Conclusions: The judicious use of TCD can enhance a comprehensive diagnostic and monitoring strategy, complementing traditional clinical and laboratory assessments in the management of MPN specifically PV and ET.

References

  1. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016 May 19;127(20):2391-405. doi: 10.1182/blood-2016-03-643544. Epub 2016 Apr 11. PMID: 27069254.

  2. Barbui T, Finazzi G, Falanga A. Myeloproliferative neoplasms and thrombosis. Blood. 2013 Sep 26;122(13):2176-84. doi: 10.1182/blood-2013-03-460154. Epub 2013 Jul 3. PMID: 23823316.

  3. Blaser, T., Krueger, S., Kross, R., Lutze, G., Franke, A., Wieker, K., & Goertler, M. (2001). Acetylsalicylic acid induced cessation of transient ischaemic attacks and microembolic signals detected by transcranial Doppler in a patient with essential thrombocythaemia. Journal of Neurology, 248(1), 67–68. doi:10.1007/s004150170274

  4. Cinar A, Cetin G, Altintas Kadirhan O, Turgut S, Ekinci I, Asil T. Determination of cerebral blood flow velocity and microembolic signals in essential thrombocytosis by transcranial doppler ultrasonography. Neurol Res. 2021 Feb;43(2):157-163. doi: 10.1080/01616412.2020.1833147. Epub 2020 Oct 14. PMID: 33050838.

  5. Del Sette, M., Finocchi, C., Angeli, S., Conti, M., & Gandolfo, C. (1995). Transcranial Doppler Detection of Microemboli in a Stroke Patient with Polycythemia rubra vera. Cerebrovascular Diseases, 5(3), 208–211. doi:10.1159/000107854

  6. Elliott MA, Tefferi A. Thrombosis and haemorrhage in polycythaemia vera and essential thrombocythaemia. Br J Haematol. 2005 Feb;128(3):275-90. doi: 10.1111/j.1365-2141.2004.05277.x. PMID: 15667529.

  7. Falanga A, Marchetti M. Thrombosis in myeloproliferative neoplasms. Semin Thromb Hemost. 2014 Apr;40(3):348-58. doi: 10.1055/s-0034-1370794. Epub 2014 Mar 9. PMID: 24610470.

  8. Fiermonte G, Aloe Spiriti MA, Latagliata R, Petti MC, Giacomini P. Polycythaemia vera and cerebral blood flow: a preliminary study with transcranial Doppler. J Intern Med. 1993 Dec;234(6):599-602. doi: 10.1111/j.1365-2796.1993.tb01019.x. PMID: 7903108.14.

  9. King A, Markus HS. Doppler embolic signals in cerebrovascular disease and prediction of stroke risk: a systematic review and meta-analysis. Stroke. 2009 Dec;40(12):3711-7. doi: 10.1161/STROKEAHA.109.563056. Epub 2009 Oct 22. PMID: 19850894.

  10. Lu X, Chang R. Polycythemia Vera. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557660/

  11. Purkayastha S, Sorond F. Transcranial Doppler ultrasound: technique and application. Semin Neurol. 2012 Sep;32(4):411-20. doi: 10.1055/s-0032-1331812. Epub 2013 Jan 29. PMID: 23361485; PMCID: PMC3902805.

  12. Richter V, Savery MD, Gassmann M, Baum O, Damiano ER, Pries AR. Excessive erythrocytosis compromises the blood-endothelium interface in erythropoietin-overexpressing mice. J Physiol. 2011 Nov 1;589(Pt 21):5181-92. doi: 10.1113/jphysiol.2011.209262. Epub 2011 Aug 22. Erratum in: J Physiol. 2011 Dec 15;589(Pt 24):6249. PMID: 21859826; PMCID: PMC3225673.

  13. Rungjirajittranon T, Owattanapanich W, Ungprasert P, Siritanaratkul N, Ruchutrakool T. A systematic review and meta-analysis of the prevalence of thrombosis and bleeding at diagnosis of Philadelphia-negative myeloproliferative neoplasms. BMC Cancer. 2019 Feb 28;19(1):184. doi: 10.1186/s12885-019-5387-9. PMID: 30819138; PMCID: PMC6393965.

  14. Segura, T., Serena, J., Teruel, J., & Dávalos, A. (2000). Cerebral embolism in a patient with polycythemia rubra vera. European Journal of Neurology, 7(1), 87–90. doi:10.1046/j.1468-1331.2000.00008.x

  15. Spivak JL. Polycythemia vera: myths, mechanisms, and management. Blood. 2002 Dec 15;100(13):4272-90. doi: 10.1182/blood-2001-12-0349. Epub 2002 Aug 8. PMID: 12393615.

  16. Srour SA, Devesa SS, Morton LM, Check DP, Curtis RE, Linet MS, Dores GM. Incidence and patient survival of myeloproliferative neoplasms and myelodysplastic/myeloproliferative neoplasms in the United States, 2001-12. Br J Haematol. 2016 Aug;174(3):382-96. doi: 10.1111/bjh.14061. Epub 2016 Apr 7. Erratum in: Br J Haematol. 2017 Apr;177(2):331. PMID: 27061824; PMCID: PMC4961550.

  17. Sudheer P, Misra S, Nath M, Kumar P, Vibha D, Srivastava MVP, Tripathi M, Bhatia R, Pandit AK, Singh RK. Micro-embolic signal monitoring in stroke subtypes: A systematic review and meta-analysis of 58 studies. Eur Stroke J. 2021 Dec;6(4):403-411. doi: 10.1177/23969873211060819. Epub 2021 Nov 13. Erratum in: Eur Stroke J. 2023 Mar;8(1):402. PMID: 35342814; PMCID: PMC8948512.

  18. Wang W, Liu W, Fidler T, Wang Y, Tang Y, Woods B, Welch C, Cai B, Silvestre-Roig C, Ai D, Yang YG, Hidalgo A, Soehnlein O, Tabas I, Levine RL, Tall AR, Wang N. Macrophage Inflammation, Erythrophagocytosis, and Accelerated Atherosclerosis in Jak2 V617F Mice. Circ Res. 2018 Nov 9;123(11):e35-e47. doi: 10.1161/CIRCRESAHA.118.313283. PMID: 30571460; PMCID: PMC6309796.

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