Esophageal Variceal Hemorrhage Secondary to Post-Polycythemic Myelofibrosis
Bibliographic record
Abstract
A 71-year-old male presented to the emergency department with hematochezia and a hemoglobin drop from 90 to 70 g/L. His medical history was significant for polycythemia rubra vera that transformed to myelofibrosis (MF), but there was no known liver disease. On examination, he was hemodynamically stable with marked splenomegaly, but he had no other signs of portal hypertension (PH). Bloodwork demonstrated normal liver enzymes and function. Upper endoscopy showed varices (Figure 1). CT venogram revealed patent portal and hepatic veins with no thrombus. Massive splenomegaly (>30 cm) was noted. A severely dilated splenic vein (2.5 cm) communicated with an enlarged portal vein (1.8 cm) (Figure 2). Endoscopic variceal ligation (EVL) was performed and nonselective beta-blocker (NSBB) therapy was initiated before discharge. Upper endoscopy demonstrating medium esophageal varices with high-risk stigmata. A fibrin clot was present at the distal aspect of one column (not shown). He also had nonbleeding gastroesophageal varices (GOV1 and GOV2) (not shown). Upper endoscopy demonstrating medium esophageal varices with high-risk stigmata. A fibrin clot was present at the distal aspect of one column (not shown). He also had nonbleeding gastroesophageal varices (GOV1 and GOV2) (not shown). Axial CT sections demonstrating massive splenomegaly with a severely dilated splenic vein. Axial CT sections demonstrating massive splenomegaly with a severely dilated splenic vein. As a complication of MF, PH can occur without development of portal vein thrombus (1). PH has rarely been documented in post-polycythemic MF (2). The mechanism of PH in absence of thrombosis is proposed to be extramedullary hematopoiesis in the liver and infiltration of sinusoids with myeloid cells or increased portal flows secondary to splenomegaly (3, 4). Small studies have shown PH develops in approximately 11% of MF individuals; however, the National Comprehensive Cancer Network provides no guidance on screening for portal hypertension (2, 4). Traditional strategies to treat complications of cirrhotic PH have been utilized for MF, including EVL, NSBB and transjugular intrahepatic portosystemic shunting (1, 2). Given the frequency of PH in MF and potential catastrophic complications, further study should explore potential merits of endoscopic screening. DM described the case. DM and TK conducted the literature review and wrote the manuscript. TK conceived the study. IE supervised the project.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".