Budd-Chiari syndrome in very young adult patients with polycythemia vera: report of case series with good outcome with direct thrombin inhibitor treatment.
Polycythemia vera is a Philadelphia chromosome-negative myeloproliferative disorder with incidence of 1% under the age of 25. The Budd-Chiari syndrome (BCS) is a well known complication of polycythemia vera even in children, and characterized by occlusion of hepatic outflow. A computerized archive search of medical records at Sheba Medical Center of the past three decades of patients with polycythemia vera and BCS under the age of 25 years was performed. A work-up for JAK2 V617F mutation and thrombophilia was done. Medical charts and imaging tests were carefully reviewed. Three patients under the age of 22 were finally recruited. Two of those were found in life-threatening condition and improved clinically following treatment with bivalirudin, a direct thrombin inhibitor. It is conceivable that bivalirudin contributed to a favorable outcome of those patients in comparison to historical outcome previously reported. In conclusion, polycythemia vera in the young is not a mild disease since BCS, which is one of its complication, can be fatal even in those age group unrelated to the presence of hereditary thrombophilia. Once BCS occurs, we would suggest giving a trial with bivalirudin before an invasive procedure is planned.
aPediatric Hemato-Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children Hospital bDepartment of Gastroenterology cDepartment of Diagnostic Imaging dDepartment of Internal Medicine C eThe Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Gal
G
Goldstein
Jacob
J
Maor
Yeruham
Y
Kleinbaum
Michal
M
Palumbo
Yehezkel
Y
Sidi
Ophira
O
Salomon
D000293:Adolescent; D000991:Antithrombins / Q000627:therapeutic use*; D006502:Budd-Chiari Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D002648:Child; D005260:Female; D006629:Hirudins; D006801:Humans; D053614:Janus Kinase 2 / Q000235:genetics; D008099:Liver / Q000098:blood supply / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D008297:Male; D009154:Mutation; D010446:Peptide Fragments / Q000627:therapeutic use*; D011087:Polycythemia Vera / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D011994:Recombinant Proteins / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors / Q000378:metabolism; D019851:Thrombophilia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000235:genetics; D016896:Treatment Outcome; D055815:Young Adult
D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C507924:JAK2 protein, human; D053614:Janus Kinase 2; D013917:Thrombin; C074619:bivalirudin