title: Haemostatic Profile in Patients of Myeloproliferative Neoplasms-A Tertiary Care Centre Experience.
abstract: BACKGROUND
  Patients of MPN commonly present with abnormalities in laboratory coagulation tests that are consistent with hypercoagulable state. Some individuals with MPN exhibit a pattern of exclusive bleeding or thrombotic events; many others have both bleeding and thrombosis during the course of the disease.
  
  
  OBJECTIVE
  This study was undertaken to assess the haemostatic defects and platelet functions in patients of MPN.
  
  
  METHODS
  One year prospective study was conducted at a tertiary care centre in North India in Department of Pathology in collaboration with Department of Clinical Haematology. All recently diagnosed cases of MPN along with 30 age and sex matched controls were included. Patients on antiplatelet drugs, antimyeloproliferative treatment, vitamin K agonists or antagonists, OCPs, Platelet count <1,00,000/μl, high grade fever, liver disease, pregnancy were excluded from this study. All the patients underwent screening investigations like CBC, peripheral smear evaluation, BT, PT, aPTT, Protein C and S measurement (clot based assay) and aggregation studies with ADP (5μM) (Optical Aggregometry with AGGRO/LINK 8 software and CHRONOLOG 700 aggregometer).
  
  
  RESULTS
  In present study, 50 cases were included. There was an occult prothrombotic state, suggested by significantly (p<0.001) reduced levels of Protein C and Protein S, but no patient presented with frank thrombosis while 8 out of 50 patients had haemorrhagic manifestations ranging from subdural haematoma to pin point petechial haemorrhages. Patients of CML-CP, ET, PV, PMF, MPN-NOS showed significantly reduced maximal aggregation with ADP (5μM) when compared to control (p<0.001). MPV also showed a statistically significant increase in these patients.
  
  
  CONCLUSIONS
  Thrombohaemorrhagic complications significantly affect the morbidity and mortality of MPN patients. This can be assessed by the use of platelet aggregation studies, Protein C and S activities and other coagulation studies. Timely diagnosis of these prothrombotic/haemorrhagic states can decrease the morbidity in these patients.
authors.affiliation: Junior Resident, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Yatendra
authors.initials: Y
authors.lastname: Parashar
authors.affiliation: Associate Professor, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kushwaha
authors.affiliation: Professor and Head, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Professor, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Kamal
authors.initials: K
authors.lastname: Agarwal
authors.affiliation: Professor, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: U S
authors.initials: US
authors.lastname: Singh
authors.affiliation: Assistant Professor, Department of Pathology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: Mili
authors.initials: M
authors.lastname: Jain
authors.affiliation: Assistant Professor, Department of Clinical Hematology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: S P
authors.initials: SP
authors.lastname: Verma
authors.affiliation: Head of Department of Clinical Hematology, King George's Medical University , Lucknow, Uttar Pradesh, India .
authors.forename: A K
authors.initials: AK
authors.lastname: Tripathi
keywords: Haemorrhage; Platelet dysfunction; Thrombosis