Clinical Analysis Of 104 Case Of Nonleukemic Myeloproliferative Disorders

CNLMD is a kind of diseases which comes of haemopoietic stemcells.Besides of hematology changes, they shear the common feature thatinclude embolism, haemorrhage, splenohepatomegalia, myeloid metaplasiaand excessive nucleoprotein destruction.However, each of them has specialfeatures on hematology and clinical manifestation. Most of the data onlarge-scale clinical trials were generated from western countries. Moreover,there were a lot of analyses for every disease of this generic group (PV orETor IMF) in China, but few comprehensive analyses for CNLMD areavailable. This kind of diseases is fewer relatively, and we have poorly masteit. So misdiagnosis and missed diagnosis often take place, and to raise thevigilance to CNLMD is necessary very much. It is very important thatCNLMD is diagnosed, treated efficiently in time and acutely complication isavoided to reduce unnecessary operation risk. Materials and methods: 104 patients with CNLMD admitted to ourhospital between January 2001 and December 2005 were involved in thisstudy.Their age, sex, clinical manifestation and laboratory data wereretrospectively analyzed. All data was imported into databank on computer,and was statistics analyzed with JMTJFX software. Result: 1. Among the groups of PV, ET and IMF, the age distributionshowed no significant difference (P>0.05) by Kruskal-Wallis test.Theymedian was 55yr. 82.7% of patients were more than 40yr.There were morepatients who were belonged to 40-80yr population., and there were mostpatients who were belonged to 60-69yr population.26.9% were belonged to60-69yr population. 2. Except of embolism and haemorrhage, the three groupshave significant difference (P<0.05) in red face, limbs numbness, eyesightdescent, morbid forgetfulness, fatigue, pale, fever, Itch of skin and pepticulcer. In other symptoms they have no significant difference (P>0.05).Between the groups of PV and the other two, the condition of red face,eyesight descent, morbid forgetfulness, Itch of skin and peptic ulcer showedsignificant difference (P<0.05), and showed no significant difference (P>0.05)between ET and IMF. Between the groups of IMF and the other two, thecondition of limbs numbness showed significant difference (P<0.05), andshowed no significant difference (P>0.05) between PV and ET. Between thegroups of IMF and the other two, the condition of fatigue, pale and fevershowed significant difference (P<0.05), and showed no significant difference(P>0.05) between PV and ET. 3. Among the groups of PV, ET and IMF, thecondition of haemorrhage showed no significant difference (P>0.05). Amongthe three groups, the condition of alimentary tract hemorrhage showedsignificant difference (P<0.05) and no significant difference (P>0.05) wasshowed in other hemorrhage. Embolism was observed in groups of PV and ETmostly. Between the groups of PV and ET, the condition of embolism showedno significant difference (P>0.05) in whole and in coronary artery andcerebral vessels. Between the groups of haemorrhage and no haemorrhage, thecount of platelet showed no significant difference (P>0.05). Between thegroups of embolism and no embolism, the count of platelet showed nosignificant difference (P>0.05), too. 4. Hypertension was observed in groupsof PV mostly. Between the groups of hypertension and no hypertension, thecondition of RBC, Hb, HCT, PLT and WBC, all showed no significantdifference (P>0.05). 5. The condition of hepatomegaly and splenomeg-alyshowed significant difference (P<0.05) among the three groups. Thesephenomena were observed in the group of IMF mostly. 6. In the group of PV,most patients whose MCV reduced were observed. Between the groups ofmicrocytic hypochromic and no microcytic hypochromic, the count of RBCshowed significant difference (P<0.05). The count of RBC of the group thatwas microcytic hypochromic was more than the other group. 7. Among thethree groups, the condition of active proliferation in bone marrow showed nosignificant difference (P>0.05). Prominently active proliferation in bonemarrow was observed in the group of PV and ET mostly, and poorproliferation in bone marrow was observed in the group of IMF mostly. 8.Among the groups of difference fibrosis degrees, the condition of RBC, Hb,HCT, PLT and WBC, all showed no significant difference (P>0.05). 9. Nopatient had Ph-chromosome and bcr/abl fusion gene. 10. Between the groupsof prolonged APTT and normal APTT, the count of platelet showed nosignificant difference (P>0.05). This hint that the count of platelet is not thecause of prolonged APTT. 11. Hypoglycemia was observed in the group of PVmostly. Between the groups of Hypoglycemia and normal blood glucose, thecount of RBC showed no significant difference (P>0.05) and the count ofWBC showed significant difference (P<0.05). 12. Among the three groups, thecondition of portal hypertension showed significant difference (P<0.05). Andthe rate of portal hypertension of the group of IMF was maximal.Conclusion: 1. CNLMD predominate in the middle-age or older people,the peak age at diagnosis range from 60 to 70yr. The peak age of the groups ofPV, ET and IMF range from 40 to 50yr, above 70yr and range from 60 to 70yr.In the group of PV, the count of the male exceed the female. In the group ofET, the count of the female exceed the male. In the group of IMF, the count ofthe male equal to the female on the whole. 2. The symptoms of eyesightdescent, morbid forgetfulness, Itch of skin and peptic ulcer were observed inthe groups of PV mostly. The symptom of limbs numbness was observed inthe groups of PV and ET. Fever was observed in the group of IMF mostly, andinfection was the predominant cause. 3. When a middle-age or older patienthas peptic ulcer repeatedly, the examination of hemogram shoulder beenrechecked to affirm or exclusion the condition of PV. 4. Not only the count ofcells in peripheral blood is concerned with the course of embolism, but alsoyears of age, sex, smoking and history of embolism. 5. Not only the count ofcells in peripheral blood is concerned with hypertension, but also years of age,sex and smoking. 6. Many of the patients with CNLMD have microcytichypochromic RBC, especially in the group of PV. The diminished MCV isconnected with largely increased RBC in the group of PV which causesrelative iron deficiency. 7. Many of the patients with CNLMD have prolongedAPTT. it is not correlated with the increased count of platelet. So this shouldbeen paid attention to in clinic in the future. 8. A part of patients with PV haveasymptomatic hypoglycemia, this is associated with increased white bloodcell. Redundant white blood cells consume glucose in vitro, this causeshypoglycemia. This kind of patients have no necessary to been treated.Clinical doctors should distinguish the cause of hypoglycemia, but not paymore attention to the result of exanimation purely. To invoid this phenomenon,interval time between hemospasia and chemical examination should beenshortened as far as possible.