Patients with myeloproliferative neoplasms (MPNs) sometimes experience abnormal bleeding. The bleeding can be minor and self-limiting but, rarely, bleeding can be very serious. Abnormal bleeding can show up as easy bruising, nosebleeds, or heavy period. Bleeding of the stomach or elsewhere in the digestive system or into an organ can be a medical emergency. Usually, bleeding is associated with very low platelet counts in patients with advanced myelofibrosis. Paradoxically, a very high platelet count can increase the risk of bleeding because the excess platelets can act as a sponge for certain proteins used to form clots. Some drugs used to treat MPNs can also cause bleeding if they make the platelets go too low. Patients with MPNs who are on blood thinners as treatment for an abnormal blood clot are also at risk of bleeding.
Treatment Overview
There are ways to lower the risk of bleeding in MPN patients. Patients with very high platelet counts and abnormal bleeding are generally treated with medications to normalize the platelet counts. These “cytoreductive” therapies include drugs like as hydroxyurea, anagrelide, ruxolitinib or interferon-alpha. Patients at risk of bleeding due to very high platelet counts or very low platelet counts should avoid aspirin because aspirin can further increase the risk of bleeding.
Related Faculty
Ellen K. Ritchie, M.D.
Dr. Ritchie is an Associate Professor of Medicine at Weill Cornell Medical College. She is a graduate of Barnard College and received her M.D. from Columbia University College of Physicians and Surgeons, where she was inducted into the Alpha Omega Alpha Honor Society. She completed her medical residency and fellowship in Hematology and Medical Oncology at New York Presbyterian Hospital, Columbia campus, and has been on the Cornell faculty since that time. Dr. Ritchie’s clinical and clinical research interests have been in the myeloproliferative and myelodysplatic disorders and leukemia, with special expertise in the care of older patients with hematologic malignancies. She has been the principal investigator or co-investigator of many major clinical trials related to the MPNs and the management of older patients with these blood disorders.
Clinical Profile (POPS)
Ellen K. Ritchie, M.D.
Joseph M. Scandura, M.D., Ph.D.
Dr. Joseph Scandura originally trained as an engineer earning a B.S. in Electrical Engineering from Cornell University and an M.S. in Biomedical Engineering from the University of Pennsylvania. While at Penn he enrolled in a National Institutes of Health, Medical Scientist Training Program, and earned both an M.D. and Ph.D. from Temple University. He completed his residency in Internal Medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and fellowship in Medical Oncology at Memorial Sloan-Kettering Cancer Center. He is Associate Professor of Medicine at Weill Cornell Medicine in the Division of Hematology and Medical Oncology.
Dr. Scandura has treated myeloid neoplasms for over 15 years and conducts basic and clinical research to discover new approaches to treat these diseases. Dr. Scandura is an expert in hematopoietic stem cell biology and the hematopoietic microenvironment. His work has been published in preeminent journals such as Nature, Nature Medicine, Cancer Cell, Journal of Experimental Medicine and Blood among others. He actively treats patients with myeloproliferative neoplasms and has been the Principle Investigator and Study Chair of Multi-Institutional clinical trials sponsored by the National Cancer Institute. His laboratory research has been groundbreaking and his group has identified central microenvironmental controls on hematopoietic stem cell proliferation and, with his collaborator Dr. Shahin Rafii, has discovered new ways to create new hematopoietic stem cells from blood vessel lining endothelial cells.
Dr. Scandura has received numerous honors during his career including Young Investigator Awards from the American Heart Association, the International Society for Thrombosis and Haemostasis and the American Society of Hematology. He was elected to the Alpha Omega Alpha medical honor society as a medical student and was inducted into the Red Key Society and Sphinx Head Athletic Honor Societies while at Cornell. He was the Charles A. Dana Fellow and a Leukemia & Lymphoma Society Fellow at Memorial Sloan Kettering Cancer Center. He was awarded the Department of Medicine Researcher Award at Weill Cornell. His research is funded by the National Cancer Institute, the National Heart, Lung, Blood Institute, the Empire State Stem Cell Board, the Starr Foundation, the Taub Foundation and he is a Leukemia & Lymphoma Society Scholar.
Clinical Profile (POPS)
Joseph M. Scandura, M.D., Ph.D.
Andrew I. Schafer, M.D.
Dr. Schafer’s career spans over 30 years of continuous clinical and basic laboratory research and patient care in the myeloproliferative neoplasms. He is also Chair of the MPN Research Foundation’s Scientific Board. He received his M.D. from the University of Pennsylvania, completed his residency in Internal Medicine at the University of Chicago, and his Hematology Fellowship at the Peter Bent Brigham (now Brigham and Women’s) Hospital and Harvard Medical School in Boston. He has served on the faculties of Harvard (for 13 years), Baylor College of Medicine in Houston, the University of Pennsylvania, and Weill Cornell Medical College, and he was Chair of the Department of Medicine at the last three of those institutions. He is also formerly Physician-in-Chief at the New York-Presbyterian Hospital-Weill Cornell.
He has been the Editor or Co-Editor of 7 major textbooks of Internal Medicine (including the last 2 editions of the Cecil Textbook) and hematology, and also the author of over 220 peer-reviewed original papers. Dr. Schafer has been elected to several honorary organizations, including the American Society of Clinical Investigation (for which he served as Secretary-Treasurer), the Association of American Physicians, Mastership in the American College of Physicians, Fellowship in the American Association for the Advancement of Science, and the National Academy of Medicine (formerly Institute of Medicine). He has served as elected President of the American Society of Hematology, the Association of Professors of Medicine (from which he also received the Robert H. Williams, M.D. Distinguished Chair of Medicine Award), and President-Elect of the American Clinical and Climatological Association.
Clinical Profile (POPS)
Andrew I. Schafer, M.D.
Richard T. Silver, M.D.
Dr. Richard Silver is Professor of Medicine at Weill Cornell Medical College. He received his M.D. from Cornell, where he also completed his postgraduate training in internal medicine and hematology. From the time of his early work as Clinical Associate, Leukemia Service, General Medicine Branch, National Cancer Institute, Dr. Silver has contributed to the development of modern clinical cancer chemotherapy.
Driven to increase collaboration and improve therapy for blood cancer patients, Dr. Silver returned to Weill Cornell and helped establish a Residency Training Program as a Visiting Fulbright Professor at the University of Bahia, Salvador, Brazil. This collaboration with the University of Bahia was also supported, in part, by the Rockefeller Foundation and still exists today. While in Brazil, he was able to journey to study the blood groups of the native people of the upper Xingu River region, where he discovered a new blood subgroup.
He is internationally recognized as one of the pioneers in clinical investigation of the MPNs, including CML. Among his many accomplishments in the field, Dr. Silver has steered the development and broad clinical application of interferons for the treatment of these diseases, and continues to be an actively practicing and publishing leader in clinical research in the MPNs. He is widely credited with developing the use of the bone marrow biopsy technique that is used throughout the world for the diagnosis of hematologic disorders. He has written over 300 peer-reviewed articles, written or edited more than four books and 20 chapters and innumerable abstracts. He is routinely listed among the Best Doctors in New York.
He has organized or has been invited to speak at numerous national and international meetings, and consensus conferences, and has had many distinguished visiting professorships. Among his many honors for his work in myeloproliferative neoplasms, he has been awarded the Catherine Pasmantier Award, the Timothy Gee Award of the Sass & Straus Leukemia Foundation, the Lifetime Achievement Award of the Cancer Research and Treatment Fund, and the Lifetime Achievement Award of the SASS Foundation for Medical Research. He has also received an Award from the Dean of Weill Cornell Medical College for “Lifetime of Academic Achievement, Dedication and Service”, the Honorary Lifetime Achievement Awards from the Israeli Society of Hematology and the University of Texas MD Anderson Cancer Center, the Weill Cornell Alumni Association and the Myeloproliferative Neoplasms (MPN) Heroes Award. He has been past President of Weill Cornell Alumni Association; Editor of the Cornell Alumni Magazine for a decade, and has served for years as a Senior Advisor to the Weill Cornell Alumni Association. He is a Life Member of the Cornell University Council. The Silver MPN Center has been named in his honor to recognize his enduring commitment and contributions to the understanding and treatment of myeloproliferative neoplasms.
Clinical Profile (POPS)
Richard T. Silver, M.D.
Maria DeSancho, M.D.
Dr. Maria DeSancho is an Associate Professor of Medicine in the Division of Hematology and Medical Oncology at Weill Cornell Medicine. She received her medical degree from the Autonomous University in Spain and completed residencies at the La Paz Hospital in Spain and the Metropolitan Hospital Center in New York, with fellowships in hematology at Montefiore Medical Center and the Mount Sinai Medical Center, including advanced training in transfusion medicine and bone marrow transplantation. Prior to joining the Weill Cornell faculty in 2006, she was Assistant Clinical Professor at Columbia University and Assistant Attending Physician at the Mount Sinai Medical Center in New York.
Dr. DeSancho serves as Chief of the Non-Malignant Hematology Service. Dr. DeSancho has a special interest in bleeding and thrombotic disorders including in the myeloproliferative neoplasms (MPNs), particularly in pregnant and postpartum women. Dr. DeSancho diagnoses, treats and follows patients with myeloproliferative neoplasms. Additionally, Dr. DeSancho participates in a bi-monthly myeloproliferative neoplasms conference run by the Hematology and Medical Oncology Division in conjunction with the Pathology Department, as part of NewYork-Presbyterian and Weill Cornell Medicine’s commitment to offer MPN patients the best possible treatment using a multidisciplinary approach.
Clinical Profile (POPS)
Maria DeSancho, M.D.
Raymond D. Pastore, M.D.
Dr. Pastore received his undergraduate degree summa cum laude from Princeton University, his medical degree with Honors from the NYU School of Medicine, and performed his residency in internal medicine as well as his fellowship in hematology and medical oncology at Weill Cornell Medical Center. He was Chief Medical Resident from 2001-2002. During his training, he received a Master of Science degree in Clinical Epidemiology & Health Services Research from the Weill Cornell Graduate School of Medical Sciences.
Dr. Pastore sees patients and develops a clinical and translational research program related to non-malignant blood disorders. He is also involved in teaching hematology-oncology fellows, medical residents and medical students.
Clinical Profile (POPS)
Raymond D. Pastore, M.D.