Hello, I am looking for someone to write an article on Myelofibrosis. It needs to be at least 2500 words. Mr. Spring’s age and compromised cardiac status, plus the longer-term nature of his myelofibrotic symptoms, can increase Mr. Spring’s danger of future morbidity or mortality as compared to a younger patient with a healthier circulatory function.
Since Mr. Spring has survived the surgery, he has already overcome one of the biggest causes of deaths—perioperative mortality due to extensive bleeding. In a Mayo study of 223 serial patients, it was found that 20 out of 223, or 9%, died during or shortly after the operation (Tefferi 2000). For the most part, those patients who died suffered from thrombocytopenia. In many cases where the patient survived, ongoing thrombocytopenia was a continuing concern. A secondary concern was a returning nonhypercellular bone marrow, which also limited post-splenectomy survival time.
In addition, patients suffered from an enlarged liver and marked an increase in the number of platelets (16 and 22% respectively). Another study, performed in Brazil, found that some patients had a symptomatic recurrence of their disease (Petroianu 1996).
A study performed in France at the CNRS found a similar mortality rate to the Mayo study (8.4%) on a smaller sample population (n=71) (Barosi, et al. 1993). In this case, morbidity at 40% was quite high but unpredictable. As at Mayo, the figures were very similar for new thrombotic or hemorrhagic complications (16.9%).
Although the splenectomy is generally recommended for patients over the age of 65, there are significant downsides to the surgery. In addition to losing the beneficial functions of the spleen, the patient also runs a higher risk of blast formation over a longer period of time, rising in one study from a relative risk of 2.2 at 4 years to 14.3 at 12 years (G. A. Barosi 1998) (Shayuni 1999) (Li 2001).
Mr. Spring’s prognosis may be partly .aided by his good laboratory results before and after the splenectomy.