Diagnosis, prevention, and management of bleeding episodes in Philadelphia-negative myeloproliferative neoplasms: recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO) and the Society of Thrombosis and Hemostasis Research (GTH)

Iris Appelmann; Stephan Kreher; Stefani Parmentier; Hans-Heinrich Wolf; Guido Bisping; Martin Kirschner; Frauke Bergmann; Kristina Schilling; Tim H Brümmendorf; Petro E Petrides; Andreas Tiede; Axel Matzdorff; Martin Griesshammer; Hanno Riess; Steffen Koschmieder

doi:10.1007/s00277-016-2621-2

Diagnosis, prevention, and management of bleeding episodes in Philadelphia-negative myeloproliferative neoplasms: recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO) and the Society of Thrombosis and Hemostasis Research (GTH)

Ann Hematol. 2016 Apr;95(5):707-18. doi: 10.1007/s00277-016-2621-2. Epub 2016 Feb 26.

Authors

Affiliations

¹ Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany.
² Department of Hematology and Oncology, Charite Berlin, Berlin, Germany.
³ Department of Hematology, Oncology, and Palliative Medicine, Rems-Murr-Klinikum Winnenden, Winnenden, Germany.
⁴ Department of Internal Medicine IV, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
⁵ Department of Medicine I, Mathias Spital Rheine, Rheine, Germany.
⁶ Medizinisches Versorgungszentrum Wagnerstibbe, Hannover, Germany.
⁷ Department of Hematology and Oncology, University Hospital Jena, Jena, Germany.
⁸ Hematology Oncology Centre, Ludwig Maximilians University of Munich Medical School, Munich, Germany.
⁹ Department of Haematology, Haemostasis, Oncology and Stem-Cell Transplantation, Hannover Medical School, Hannover, Germany.
¹⁰ Clinic for Internal Medicine II, Dept. of Hematology, Oncology, Asklepios Clinic Uckermark, Schwedt/Oder, Germany.
¹¹ Johannes Wesling Academic Medical Center, Minden, Germany.
¹² Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany. [email protected].

PMID: 26916570
DOI: 10.1007/s00277-016-2621-2

Abstract

Philadelphia-negative myeloproliferative neoplasms (Ph-negative MPN) comprise a heterogeneous group of chronic hematologic malignancies. The quality of life, morbidity, and mortality of patients with MPN are primarily affected by disease-related symptoms, thromboembolic and hemorrhagic complications, and progression to myelofibrosis and acute leukemia. Major bleeding represents a common and important complication in MPN, and the incidence of such bleeding events will become even more relevant in the future due to the increasing disease prevalence and survival of MPN patients. This review discusses the causes, differential diagnoses, prevention, and management of bleeding episodes in patients with MPN, aiming at defining updated standards of care in these often challenging situations.

Keywords: Bleeding; Essential thrombocythemia; Hemorrhage; MPN; Management; Myeloproliferative neoplasms; Polycythemia vera; Review.

Publication types

Consensus Development Conference
Practice Guideline
Review

MeSH terms

Anticoagulants / adverse effects
Anticoagulants / therapeutic use
Antineoplastic Agents / adverse effects
Antineoplastic Agents / therapeutic use
Blood Coagulation Factors / therapeutic use
Blood Loss, Surgical / prevention & control
Blood Transfusion
Blood Vessels / drug effects
Blood Vessels / pathology
Clinical Trials as Topic
Contraindications
Deamino Arginine Vasopressin / therapeutic use
Disease Management
Elective Surgical Procedures
Hemorrhage / diagnosis
Hemorrhage / etiology*
Hemorrhage / prevention & control
Hemorrhage / therapy
Hemostatic Techniques*
Humans
Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / complications
Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / drug therapy
Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative / genetics
Liver / physiopathology
Multicenter Studies as Topic
Myeloproliferative Disorders / complications*
Myeloproliferative Disorders / drug therapy
Myeloproliferative Disorders / genetics
Platelet Aggregation Inhibitors / adverse effects
Platelet Aggregation Inhibitors / therapeutic use
Platelet Function Tests
Platelet Transfusion
Postoperative Hemorrhage / etiology
Postoperative Hemorrhage / prevention & control
Postoperative Hemorrhage / therapy
Thrombophilia / drug therapy
Thrombophilia / etiology
Tranexamic Acid / therapeutic use
von Willebrand Diseases / etiology
von Willebrand Factor / analysis

Substances

Anticoagulants
Antineoplastic Agents
Blood Coagulation Factors
Platelet Aggregation Inhibitors
von Willebrand Factor
Tranexamic Acid
Deamino Arginine Vasopressin