Causes of erythrocytosis and its impact as a risk factor for thrombosis according to etiology: experience in a referral center in Mexico City
Antonio Olivas-Martinez1,2, Eduardo Corona-Rodarte1, Adrián Nuñez-Zuno1, Olga Barrales-Benítez3, Daniel Montante-Montes de Oca4, Jesús Delgado-de la Mora4, Diana León-Aguilar4, Hilda Elizeth Hernández-Juárez3, Elena Tuna-Aguilar3
1Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México, 2Department of Biostatistics, University of Washington, Seattle, WA, USA, 3Department of Hematology and Oncology, 4Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
Correspondence to: Elena Tuna-Aguilar, M.D.
Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, 15 Vasco de Quiroga Avenue, Mexico City 14080, Mexico
Published online: August 30, 2021.
© The Korean Journal of Hematology. All rights reserved.

Background: Thrombotic events are well documented in primary erythrocytosis, but it is uncertain if secondary etiologies increase the risk of thrombosis. This study aimed to determine the causes of erythrocytosis and to identify its impact as a risk factor for thrombosis.
Methods: Data were obtained from patients with erythrocytosis between 2000 and 2017 at a referral hospital in Mexico City. Erythrocytosis was defined according to the 2016 WHO classification. Time to thrombosis, major bleeding, or death were compared among groups of patients defined by the etiology of erythrocytosis using a Cox regression model, adjusting for cardiovascular risk factors.
Results: In total, 330 patients with erythrocytosis were studied. The main etiologies of erythrocytosis were obstructive sleep apnea (OSA) in 29%, polycythemia vera (PV) in 18%, and chronic lung disease (CLD) in 9.4% of the patients. The incidence rate of thrombosis was significantly higher in patients with PV and CLD than that in patients with OSA (incidence rates of 4.51 and 6.24 vs. 1.46 cases per 100 person-years, P=0.009), as well as the mortality rate (mortality rates of 2.72 and 2.43 vs. 0.17 cases per 100 person-years, P=0.003).
Conclusion: The risk of thrombosis in CLD with erythrocytosis was comparable to that in patients with PV. Further larger-scale studies are needed to confirm these findings and evaluate the benefits of preventive management of COPD with erythrocytosis similar to PV.
Keywords: Polycythemia vera, Secondary erythrocytosis, Thrombosis, Phlebotomy


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