The fitness-for-work evaluation of a young patient with essential thrombocythemia

We describe a case of a military cadet, a candidate for submarine service, who was diagnosed with essential thrombocythemia (ET). The estimated risk in the literature for major clinical complications in ET patients is about 5-20%. Our report concerns a young asymptomatic patient where the estimated risk is probably much lower. We think that the activity in the marine corps, which at times is involved with some degree of dehydration, might increase the risk for thromboembolic events. The possibility of a major thromboembolic complication occurring at sea could complicate and endanger the patient's life, especially when an evacuation to a hospital is required. A submarine officer has a responsibility to other people's life who depend on his skills and ability. In case of a major complication which can cause sudden incapacitation, the consequences can be catastrophic to many. Opposed to the considerations to disqualify the young cadet stands the fact that his training was expensive, and that it would be unfortunate to disqualify a very talented young person. We thus recommended to clear the cadet as a marine officer in teaching jobs, in sites were medical assistance is available in a short period of time. In our opinion he should be disqualified from serving in combat jobs where there is a greater risk for him and for the men under his command.