Determination of cerebral blood flow velocity and microembolic signals in essential trombocytosis by transcranial doppler ultrasonography

DETERMINATION OF CEREBRAL BLOOD FLOW VELOCITY AND MICROEMBOLIC SIGNALS IN ESSENTIAL TROMBOCYTOSIS BY TRANSCRANIAL DOPPLER ULTRASONOGRAPHY Introduction: Essential thrombocytosis (ET) is one of the myeloproliferative disorder that can present wıth as isolated thrombocytosis and thrombohemorrhagic complications. Presently treatment for essential thrombocytosis aims at reducing thrombohemorrhagic complications and microvascular symptoms. A study in 2013 which examined the relationship between ET and cerebrovascular disease concluded that early treatment of ET can lead to the prevention of cerebrovascular disease. Based on these study we asked ourselves whether there was increased risk of microembolism in our study transcerebral doppler ultrasonography (TCD) was used to measure cerebral blood flow velocity of patients with ET and there microembolic signal (MES) compared with those of healthy people, we thought that TCD could be used in the treatment and follow up of patients with ET. Method: A total of 40 patients with ET and 40 healthy volunteers with similar age, sex and body mass index were included in the study as control group. Participants with affected MES or those with comorbidities (diabetes mellitus, atrial fibrillation, symptomatic carotid stenosis) and those older than 65 years were excluded from the study. Microembolıc sıgnals and cerebral blood flow velocıty was measured by TCD in all patıents. In order not to affect the health of the patients and for ethical reasons all measurements were done under current treatments. Results: Transcranial doppler ultrasonographic findings of two groups were compared, MES of the right middle cerebral artery was notably higher in ET patients than control group (p:0.005). MES was detected in %18.1 of patients with platelet (PLT) count below 400.000 %72.7 wıth PLT count between 400.000 – 1.000.000 and %9.09 patients wıth PLT count over than 1.000.000 respectively. Cerebral blood velocity measured by TCD were compared between two groups and end diastolic volume- right in were significantly lower in ET groups (p<0.005). On the other hand pulsatile index-right, pulsatile index-left, resistance index-right, resistance index-left, systolic/diastolic–right, systolic/diastolic–left, mean blood flow velocity-left, systolic blood flow velocity-left was considerably higher in ET in comparison to control group (p<0.005) Conclusion: More MES was detected by TCD in patients with ET although under treatment than healthy people. ET should be monitored closely for possible cerebrovascular disease. We believe that in patients at risk, the new antiplatelets can be added to classic treatment. Keywords: Essential thrombocytosis, cerebrovascular disease, microembolic sıgnal, pulsatile index (PI), transcranial doppler ultrasonography, thrombohemorrhagic complication.