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    Patofisiologi Polisitemia Vera

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    Erni Panjaitan
    Polycythemia vera is caused by abnormal stem cells in the bone marrow that suppress normal stem cell growth and maturation. The origin of this stem cell transformation is unknown. Evidence suggests it results from an unregulated proliferation caused by a defect in signaling pathways involving growth factors like erythropoietin. Recent research indicates the Janus kinase-2 gene mutation JAK2V617F, found in most polycythemia vera patients, causes permanently activated signaling at cytokine receptors, leading to increased blood cell production. This disorder causes an elevated risk of thrombosis and bleeding due to disrupted hemostatic mechanisms from increased red blood cells and platelets.

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    Patofisiologi Polisitemia Vera

    Uploaded by

    Erni Panjaitan
    822 views2 pages
    Polycythemia vera is caused by abnormal stem cells in the bone marrow that suppress normal stem cell growth and maturation. The origin of this stem cell transformation is unknown. Evidence suggests it results from an unregulated proliferation caused by a defect in signaling pathways involving growth factors like erythropoietin. Recent research indicates the Janus kinase-2 gene mutation JAK2V617F, found in most polycythemia vera patients, causes permanently activated signaling at cytokine receptors, leading to increased blood cell production. This disorder causes an elevated risk of thrombosis and bleeding due to disrupted hemostatic mechanisms from increased red blood cells and platelets.

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    Polycythemia vera is caused by abnormal stem cells in the bone marrow that suppress normal stem cell growth and maturation. The origin of this stem cell transformation is unknown. Evidence suggests it results from an unregulated proliferation caused by a defect in signaling pathways involving growth factors like erythropoietin. Recent research indicates the Janus kinase-2 gene mutation JAK2V617F, found in most polycythemia vera patients, causes permanently activated signaling at cytokine receptors, leading to increased blood cell production. This disorder causes an elevated risk of thrombosis and bleeding due to disrupted hemostatic mechanisms from increased red blood cells and platelets.

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    822 views2 pages

    Patofisiologi Polisitemia Vera

    Uploaded by

    Erni Panjaitan
    Polycythemia vera is caused by abnormal stem cells in the bone marrow that suppress normal stem cell growth and maturation. The origin of this stem cell transformation is unknown. Evidence suggests it results from an unregulated proliferation caused by a defect in signaling pathways involving growth factors like erythropoietin. Recent research indicates the Janus kinase-2 gene mutation JAK2V617F, found in most polycythemia vera patients, causes permanently activated signaling at cytokine receptors, leading to increased blood cell production. This disorder causes an elevated risk of thrombosis and bleeding due to disrupted hemostatic mechanisms from increased red blood cells and platelets.

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    Pathophysiology

    Normal stem cells are present in the bone marrow of patients with polycythemia vera (PV). Also present are abnormal clonal stem cells that interfere with or suppress normal stem cell growth and maturation. Evidence indicates that the etiology of panmyelosis is unregulated neoplastic proliferation. The origin of the stem cell transformation remains unknown.

    Bone marrow film at 100X magnification demonstrating hypercellularity and increased number of megakaryocytes. Courtesy of U. Woermann, MD, Division of Instructional Media, Institute for Medical Education, University of Bern, Switzerland. Progenitors of the blood cells in these patients display abnormal responses to growth factors, suggesting the presence of a defect in a signaling pathway common to different growth factors. The observation that in vitro erythroid colonies grow when no endogenous erythropoietin (Epo) is added to the culture and the presence of a truncated Epo receptor in familial erythrocytosis indicate that the defect is in the transmission of the signal. The sensitivity of polycythemia vera (PV) progenitors to multiple cytokines suggests that the defect may lie in a common pathway downstream from multiple receptors. Increased expression of BCLX suggests an additional decrease in cellular apoptosis. Several reasons suggest that a mutation on the Janus kinase-2 gene (JAK2) is the most likely candidate gene involved in polycythemia vera (PV) pathogenesis, as JAK2 is directly involved in the intracellular signaling following exposure to cytokines to which polycythemia vera (PV) progenitor cells display hypersensitivity.[4] A recurrent unique acquired clonal mutation in JAK2 was found in most patients with polycythemia vera (PV) and other myeloproliferative diseases (MPDs) including essential thrombocythemia and idiopathic myelofibrosis. A unique valine to phenylalanine substitution at position 617 (V617F) in the pseudokinase JAK2 domain has been identified called JAK2V617F that leads to a permanently turned on signaling at the affected cytokine receptors.[5, 6, 7, 8] How these mutations interact with the wild type kinase genes and how they manifest into different forms of MPDs need to be elucidated. Thromboses and bleeding are frequent in persons with polycythemia vera (PV) and MPD, and they result from the disruption of hemostatic mechanisms because of (1) an increased level of red blood cells and (2) an elevation of the platelet count. There are findings that indicate the

    additional roles of tissue factor and polymorphonuclear leukocytes (PMLs) in clotting, the platelet surface as a contributor to phospholipid-dependent coagulation reactions, and the entity of microparticles. Tissue factor is also synthesized by blood leukocytes, the level of which is increased in persons with MPD, which can contribute to thrombosis. Hyperhomocystinemia is a risk factor for thrombosis and is also widely prevalent in patients with MPD (35% in controls, 56% in persons with PV). Acquired von Willebrand syndrome is an established cause of bleeding in persons with MPD, accounting for approximately 12-15% of all patients with this syndrome. von Willebrand syndrome is largely related to the absorption of von Willebrand factor onto the platelets; reducing the platelet count should alleviate the bleeding and the syndrome. Previous Next Section: Epidemiology

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