1. What is the incidence of Essential Thrombocythemia (ET) by age?
The incidence of Essential Thrombocythemia (ET) increases with age, with most patients presenting between the ages of 50 and 60 years. However, it can also be observed in young patients. ET is more common in females, with 65% of 1,494 patients with ET being female. Thrombosis is the most common cause of mortality and morbidity in patients with ET, and there is an increased risk of bleeding associated with ET, especially in cases of extreme ET with platelet counts over 1,500,000 mcL. Currently, there are no universally agreed clinical guidelines for the perioperative management of patients with ET, as demonstrated by a case of unpredictable postoperative prolonged intraperitoneal bleeding in a patient with ET who underwent operative gynecologic laparoscopy.
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2. What are the morbidities and mortalities associated with ET?
Endometrial thickening (ET) can lead to paradoxical thrombosis and bleeding tendencies, causing morbidities and mortalities. Thrombosis can result in neurological abnormalities, obstructive ileus, and bleeding. Extreme ET may lead to acquired von Willebrand syndrome, contributing to bleeding complications. In this case report, postoperative bleeding occurred despite a normal preoperative platelet count, highlighting the need for additional safety assessment parameters beyond platelet count alone. Therefore, it is crucial to consider various factors when evaluating patients with ET to prevent adverse outcomes.
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3. What is the role of flow cytometry in platelet function testing?
Flow cytometry is a promising method for platelet function testing as it is independent of platelet count. This makes it suitable for testing platelet function in patients with altered platelet counts. Studies have shown that flow cytometry can be used to evaluate platelet function in patients with essential thrombocythemia (ET) under different analytical conditions. It has been found that defective platelet functions can occur under the least physiological conditions in cases of ET. Therefore, flow cytometry can play a crucial role in identifying platelet function abnormalities in patients with ET, potentially preventing additional surgeries to identify the cause of abnormal bleeding. Additionally, there is a need for further research on the effect of cytotoxic drugs, such as hydroxyurea, on bleeding tendency in patients with ET. Overall, flow cytometry can provide valuable insights into platelet function and aid in the selection of appropriate cytotoxic medications for the perioperative period in patients with ET.
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