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PV or ET patient with organ dysfunction limiting cytoreductive choice: severe renal impai...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-PV-ET-ORGAN-DYSFUNCTION
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-ET DIS-PV
SourcesSRC-ESMO-MPN-2015 SRC-NCCN-MPN-2025

Red Flag Origin

DefinitionPV or ET patient with organ dysfunction limiting cytoreductive choice: severe renal impairment (CrCl <30 — limits HU), severe hepatic dysfunction (limits ruxolitinib), or severe cardiac dysfunction (limits anagrelide)
Clinical directioninvestigate
Categoryorgan-dysfunction

Trigger Logic

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 30
    },
    {
      "finding": "child_pugh_class",
      "value": "C"
    },
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 40
    },
    {
      "comparator": ">=",
      "finding": "nyha_class",
      "threshold": 3
    }
  ],
  "type": "composite"
}

Notes

Direction "investigate" — surfaces dose-modification / agent-substitution annotations, not a binary indication switch. CrCl <30 → reduce HU dose, monitor for myelosuppression. Hepatic dysfunction → reduce/avoid ruxolitinib (CYP3A4 substrate). Cardiac dysfunction → avoid anagrelide (PDE3-inhibitor cardiotoxicity). STUB — requires clinical co-lead signoff.

Used By

Algorithms

Indications