Budd-Chiari syndrome, or hepatic venous outflow thrombosis, is a potential complication requiring surgical intervention such as transjugular intrahepatic portosystemic shunt (TIPS), portocaval shunt, mesocaval shunt, portocaval/cavoatrial shunt, or mesoatrial shunt.[22]. J Med Case 2: 226-228. Some organizations build a community of patients and families impacted by a specific disease or group of related diseases. To manage pruritus, initial treatment should include antihistamines and selective serotonin reuptake inhibitors (SSRIs). van Genderen PJ, Mulder PG, Waleboer M, van de Moesdijk D, Michiels JJ. There is currently no difference in treatment recommendations for patients with underlying PV. JAK inhibitors; JAK2 V617F mutations; myeloproliferative neoplasms; paediatric/juvenile/adult polycythemia vera; tyrosine kinase inhibitors. 2019; doi:10.1111/ejh.13291. Trends in the incidence of polycythemia vera among Olmsted County, Minnesota residents, 1935-1989. Secondary polycythemia (from hypoxia or smoking) is much more common than primary PV and must be ruled out before the diagnosis of primary PV can be made. Learn PV symptoms, risk factors, diagnosis, and treatment. Tower 1, Capital Square, Vci t 76. Click here to learn more or call our office at 561-912-9993. Prevention of bacterial endocarditis in dental patients. Blood Cancer Journal. This page is currently unavailable. A 65 year old male patient reported to the outpatient department of Periodontology, SGT Dental College, Budhera with the chief complaint of bleeding gums, mobility of teeth and difficulty in mastication since one month. These excess cells thicken your blood, slowing its flow, which may cause serious problems, such as blood clots. Medications that are normally used to treat depression, called selective serotonin reuptake inhibitors (SSRIs), helped relieve itching in clinical trials. There is often a concurrent stimulation of myeloid and megakaryocytic lineages, leading to increased white blood cell and platelet production. Five-year survival in the overall cohort was 79.5%, but patients are at a high risk of second primary malignancies and leukemic transformation, which may compromise long-term survival.[28]. Current Treatment Options in Oncology. Is this condition temporary, or will I always have it? Doctors, other trusted medical professionals, and patient organizations may also be aware of studies.To determine whether a study may be appropriate: How do you find the right clinical study? A single copy of these materials may be reprinted for noncommercial personal use only. privacy practices. 2019; doi:10.2147/JBM.S189922. 2022 Jun;117(6):872. doi: 10.1111/vox.13287. Tefferi A, Rumi E, Finazzi G, Gisslinger H, Vannucchi AM, Rodeghiero F, Randi ML, Vaidya R, Cazzola M, Rambaldi A, Gisslinger B, Pieri L, Ruggeri M, Bertozzi I, Sulai NH, Casetti I, Carobbio A, Jeryczynski G, Larson DR, Mllauer L, Pardanani A, Thiele J, Passamonti F, Barbui T. Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study. Accessed Dec. 7, 2019. Because invasive dental treatmentfor patients with PV can cause uncontrolled hemorrhage or thrombosis, including disseminated intravascular coagulation (DIC), careful preoperative assessment and treatment planningare needed. Mayo Clinic Q and A: Blood disorder causes body to make too many red blood cells. Your doctor may recommend that you take a low dose of aspirin to reduce your risk of blood clots. Polycythemia vera. Possible complications of polycythemia vera include: Connect with others like you for support and answers to your questions in the Blood Cancers & Disorders support group on Mayo Clinic Connect, a patient community. Would you like email updates of new search results? Treatment focuses on reducing your risk of complications. Polycythemia vera is a blood cell disorder that causes the body to make too many blood cells. Streiff MB, Smith B, Spivak JL. Praxis (Bern 1994). Polycythemia vera and essential thrombocythemia: 2019 update on diagnosis, risk-stratification and management. Aquagenic Pruritus in Polycythemia Vera: Clinical Characteristics. Polycythemia vera (PV) may initially present with vague symptoms including headache, dizziness, fatigue, insomnia, GI complaints, pruritus, etc., and patients may initially bring this to the attention of the general practitioner. There is a signaling defect leading to an abnormal response to growth factors, and the abnormal clonal line interferes with normal lineage proliferation. The concerns and consequences of dental care in these patients are discussed and recommendations for dental treatment are given. Efficacy and safety of low-dose aspirin in polycythemia vera. Diagnosis of PV is currently according to WHO criteria and based on a composite assessment of clinical and laboratory feature [8]. Each unit of phlebotomized blood (500 mL) should drop the hematocrit by 3% in an average-sized adult. If you're diagnosed with polycythemia vera, you might be referred to a doctor who specializes in blood conditions (hematologist). Lelonek E, Matusiak , Wrbel T, Szepietowski JC. StatPearls Publishing, Treasure Island (FL). Blood 110(4): 1092-1097. The discourse on genetics includes an expos on the molecular biology of the disease and how a . sharing sensitive information, make sure youre on a federal If you would like to request an appointment, feel free to use our convenient online contact form. Normal saline may be given post phlebotomy to replace the volume lost. Ana BJ, Suman VJ, Sobell JL, Codd MB, Silverstein MN, Melton LJ. Leukocytosis, predominantly with neutrophils, can be seen without blast activity. Patients failing hydroxyurea therapy or who are intolerant may try pegylated interferon or busulfan. The neurologic complications of polycythemia vera result primarily from increased viscosity of the blood. The Power of Extracellular Vesicles in Myeloproliferative Neoplasms: "Crafting" a Microenvironment That Matters. It is recommended that a hematologist be involved in the care of patients with polycythemia vera (PV). In the US, there are less than 200,000 with this disease. Keywords: Bone marrow sampling typically shows hypercellularity with panproliferation. Whereas women, the elderly, those who weigh less than 50 kg, or those with cardiovascular disease may only tolerate removal of 0.5 units a week. It usually develops slowly, and you might have it for years without knowing. Tefferi A, et al. About Us. Hematocrit level >52 percent (0.52) in white men, >47 percent (0.47) in blacks and women, Hemoglobin level >18 g per dL (180 g per L) in white men, >16 g per dL (160 g perL) in blacks and women), Transient neurologic complaints (headache, tinnitus, dizziness, blurred vision, paresthesias), Stroke, heart attack, deep vein thrombosis, pulmonary embolism. A blood clot could also travel to the heart or brain, which leads to an increased risk for heart attack or stroke. Polycythemia Vera is an uncommon myeloproliferative disease that can have hematologic and surgical implications. Treatment Planning for Dental Implants: A Rationale for Decision Making Part 1: Total Edentulism . Polycythemia is classified into primary and secondary, with polycythemia vera referring to the primary type. Try not to scratch, as it can damage your skin and increase the risk of infection. Risk factors associated with PCV are age (>60) and sex (men affected more than women). We study 4,784 people who have Polycythemia vera or Pregnancy with implant contraceptive. This content does not have an Arabic version. Slakey DP, Klein AS, Venbrux AC, Cameron JL. In polycythemia vera (PV) red blood cell (RBC) volume increases to an erythrocyte count of 6 to 12 million/mm, with a hemoglobin concentration of 18 to 24 g/dL, leading to increased blood viscosity and thrombosis. Saini KS, Patnaik MM, Tefferi A. Polycythemia vera-associated pruritus and its management. During Phlebotomy blood, normally one unit is removed at a time every week, until the blood is thinned out. 2019; doi:10.1111/ejh.13291. The risk for bleeding increases with severe thrombocytosis and high-dose aspirin (more than 100 mg/day) or anticoagulation.[25]. Postsurgery outcomes in patients with polycythemia vera and essential thrombocythemia: a retrospective survey. The treatment plan advised to the patient was complete prosthetic replacement following total extraction. The concerns and consequences of dental care in these patients are discussed and recommendations for dental treatment are given. Review/update the The first-line agent is hydroxyurea (HU) due to its safety profile, cost, and efficacy. PV may only be discovered when blood counts are done during a periodic health examination (Table 2). MGUS monitoring: What tests do you have done regularly? Polycythemia vera was first reported in the medical literature in 1892. Scott SD, Garfunkel A, Greenberg MS (1992) Hematologic Diseases. There's no cure for polycythemia vera. : The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Polycythemia vera is a myeloproliferative disorder associated with a Janus kinase-2 (JAK2) mutation that causes the neoplastic proliferation of the hematopoietic progenitor cells. This site complies with the HONcode standard for trustworthy health information: verify here. Drug resistance is circumvented by artfully switching drugs or using novel drug designs. Van de Ree-Pellikaan C, et al. [1]Cytogenetic studies show the presence of an abnormal karyotype in the hematopoietic progenitor cells in approximately 34% of patients with PV. Thrombosis is a major complication of polycythemia vera (PV), and current treatment recommendations aim to minimize these risks. Citing Literature. https://www.nhlbi.nih.gov/health-topics/polycythemia-vera. Organizations specific to this condition are available to help find support. . In contrast to secondary polycythemias, PCV is associated with a low serum level of the hormone erythropoietin (EPO). Affordable Dentures & Implants offers customized, high-quality dental treatment plans for each patient. 2019; doi:10.2147/JBM.S189922. Common symptoms of problems in the digestive system include blood in the stool, changes in bowel habits, severe abdominal pain, unintentional weight loss, or heartburn. Get Treatment Now and Pay for it Over Time. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Patients under the age of 60 without a history of thrombotic events are considered low risk, and treatment recommendations include: Patients 60 years of age or older and/or who have a history of thrombosis are considered high risk. http://creativecommons.org/licenses/by-nc-nd/4.0/. Cimetidine was given (H2 receptor antagonists) to relieve gastrointestinal symptoms of peptic ulceration. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Polycythemia vera. Accessed Dec. 7, 2019. The current understanding of pathophysiology involves increased sensitivity to growth factors due to an abnormal hematopoietic cell clone. The average survival of untreated polycythemia vera (PV) is 18 months,whereas median survival is 14 years overall and 24 years if younger than 60 for those undergoing treatment. It is emphasized that important physiologic and pathogenic components of the illness relate not only to the erythroid cell, but also to the megakaryocyte. A single copy of these materials may be reprinted for noncommercial personal use only. Accessed Dec. 7, 2019. November 1991. Unable to load your collection due to an error, Unable to load your delegates due to an error. Polycythemia vera is a condition characterized by an increased number of red blood cells in the bloodstream (erythrocytosis). and transmitted securely. Researchers from participating institutions use the database to search for patients or healthy volunteers who meet their study criteria. Polycythemia vera is an uncommon myeloproliferative disease that can have hematologic and surgical implications. Tablet traxemic 500 mg qid was started one day before to prevent hemorrhagic event. Most cases of PV are not inherited and are acquired during a person's lifetime. 10. [21] Initial dosing is 15 mg/kg of actual body weight per day divided into twice-daily dosing. On intra-oral examination it was found that there was mobility present in relation to all the teeth, red inflammed gingiva with loss of stippling which bled profusely on slight provocation, generalized recession, gingival enlargement present in relation to all the teeth, attrition and root caries present in relation to 45. Virtually all patients with polycythemia vera harbor JAK2 mutations. which Vox Sang. EPO assay difference between primary and secondary PCV are EPO is normal or high in secondary PCV. 11. Call 1 877-658-1673 to learn more about our Dentures In Florida. Research also helps doctors better understand how well a treatment works and can lead to new treatment discoveries. 2021 Sep 4;10(9):2316. doi: 10.3390/cells10092316. To provide you with the most relevant and helpful information, and understand which Polycythemia vera (PCV), being a primary polycythemia, is caused by neoplastic proliferation and maturation of erythroid, megakaryocytic and granulocytic elements to produce what is referred to as panmyelosis. The FDA approved a JAK inhibitor (ruxolitinib) in 2014 to treat patientswith PV who have an inadequate response or are intolerant of hydroxyurea. https://www.uptodate.com/contents/search. The concerns and consequences of dental care in these patients are discussed and recommendations for dental treatment are given. Unable to load your collection due to an error, Unable to load your delegates due to an error. Low dose aspirin (40 mg to 100 mg) once or twice daily should be given, if no contraindications, to lower thrombotic risk. The https:// ensures that you are connecting to the Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version | Opera | Terms and Conditions | Privacy Policy, MPD: Myeloproliferative Disorder; MPNs: Myeloproliferative Neoplasms; PV: Polycythemia Vera; RBC: Red Blood Cell; OPD: Outpatient Department; OPG: Orthopantogram; EPO: Erythropoietin, Polycythemia vera dental management case report. European Journal of Haematology. Are there brochures or other printed material I can have? Table 3: World health organisation (who) diagnostic criteria for polycythemia vera [12]. What's the most likely cause of my symptoms? Polycythemia vera (PV) is a condition where the bone marrow goes into overdrive and makes too many red blood cells, along with too many white blood cells and platelets. The term chronic Blood Dyscrasias refers to any pathologic condition of the blood involving disorders of the bloods cellular components (platelets, white blood cells, or red blood cells) or soluble plasma components required for proper coagulation. CDHO Advisory, p. 1-14. Familial erythrocytosis associated with a short deletion in the erythropoietin receptor gene. Polycythaemia vera is one of several classical myeloproliferative neoplasms that may occur in a juvenile onset or late-onset adult forms. James C, Ugo V, Le Coudic JP, Staerk J, Delhommeau F, Lacout C, Garon L, Raslova H, Berger R, Bennaceur-Griscelli A, Villeval JL, Constantinescu SN, Casadevall N, Vainchenker W. A unique clonal JAK2 mutation leading to constitutive signalling causes polycythaemia vera. Here's some information to help you get ready for your appointment. Polycythemia vera is a chronic blood disorder in which the body makes too many red blood cells. Thromboembolic events in polycythemia vera. A bone marrow biopsy involves taking a sample of solid bone marrow material. If HU is not tolerated, cytoreductive therapy should be changed to other agents listed above. Currently GARD is able to provide the following information for Polycythemia vera: An unpleasant sensation characterized by physical discomfort (such as pricking, throbbing, or aching) and perceived to originate in the abdomen. . Both play essential roles in causing complications . Polycythemia vera. These changes really have made a difference in my life. All rights reserved. [11] Bleeding and thrombotic complications are each observed in 1% of patients. How did you make the final decision to begin HU protocol for ET? You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. J Indian Oral Med Radiol 24(2): 155-157. official website and that any information you provide is encrypted CHIEVITZ E, THIEDE T. Complications and causes of death in polycythaemia vera. The most difficult to manage is Polycythemia vera (PV), a myeloproliferative disorder characterized by excessive proliferation of erythroid elements along with granulocytic and megakaryocytic cells. Blood withdrawals The most common treatment for polychythemia vera is having frequent blood withdrawals, using a needle in a vein (phlebotomy). In rare cases, the risk for PV runs in families and may be inherited in an autosomal dominant manner. Haematologica. We would like to hear your feedback as we continue to refine this new version of the GARD website. [5] This mutation is observed in over 90% of patients with PV and 50% to 60% of primary myelofibrosis, and 50% of essential thrombocythemia. Khanal N, Giri S, Upadhyay S, Shostrom VK, Pathak R, Bhatt VR. Treatment strategies for polycythemia vera: Observations in a Dutch "real-world" cohort study. In 2008, the World Health Organization reclassified MPDs to "myeloproliferative neoplasms" (MPNs) to reflect the consensus that these diseases are To reduce itching, bathe in cool water, use a gentle cleanser and pat your skin dry. . There is no cure for polycythemia vera (PV); treatment goals are aimed at symptom relief and reducing the risk of disease complications, including thrombosis, bleeding, and hematologic transformation. AskMayoExpert. . Polycythemia vera (PV) is the most common myeloproliferative neoplasm (MPN), the ultimate phenotype of the JAK2 V1617F mutation, the MPN with the highest incidence of thromboembolic complications, which usually occur early in the course of the disease, and the only MPN in which erythrocytosis occurs. Dental management of mild hemophilia with polycythemia vera. Polycythemia vera is a rare, chronic disorder involving the overproduction of blood cells in the bone marrow (myeloproliferation). When to initiate the dental procedures proposed in Polycythemia Vera patients, The dental hygienist should consult with the primary care physician or hematologist to obtain. In this article, we report a rare case of Polycythemia Vera at dental outpatient department (OPD), its oral manifestations and its management in the dental clinic. Cells. Polycythemia vera, alternative terminology for primary polycythemia. Therefore, the PVSG guidelines have fallen out of favor, and the World Health Organization (WHO) published revised guidelines for diagnosing PV in 2016. Patient gave past medical history of PCV since 2003 and on being medications for the same which included: Hydroxyurea- 500 mg twice daily as cytoreductive agent to decrease the leukemogenic risk and ecosprin -75 mg (low dose aspirin) to lessen the risk of thrombosis in an artery. Spivak JL, Silver RT. The study is created by eHealthMe and uses data from the Food and Drug Administration (FDA). Gordon Atherle Y, Lisa Taylor (2012) Polycythemia. Principle of Medicine 2: 429-453. Other alternatives include ruxolitinib, anagrelide, pipobroman, and radioactive phosphorus.[17][20]. Griesshammer M, et al. HHS Vulnerability Disclosure, Help 2018; doi:10.1038/s41408-017-0042-7. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. What do organizations that focus on a medical condition do? Before Red blood cells are produced in the bone marrow, where hematopoietic stem cells are . A DVT can sometimes travel through the blood stream to the lungs, which can cause a pulmonary embolism and is very dangerous. Make a donation. Mayo Clinic Q and A: Blood disorder causes body to make too many red blood cells, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Patient was advised Orthopantogram (OPG) which showed generalized horizontal bone loss extending upto two third of root surface of almost all the teeth present (Figures 1&2). Accessed Dec. 7, 2019. 2019 Sep;108(13):835-842. doi: 10.1024/1661-8157/a003317. PMC Polycythemia vera (pol-e-sy-THEE-me-uh VEER-uh) is a type of blood cancer. Bethesda, MD 20894, Web Policies Myelofibrosis worsens with the progression of the disease. Cancer 2009;115:1692-700, Schwartz J, Padmanabhan A, Aqui N, et al. 2019; doi:10.1007/s00277-019-03625-x. He is a member of the ADA, AAE and Miami Dade -Dental Society. Your doctor will take a detailed medical history and perform a physical exam. Lu X, Chang R. Polycythemia Vera. Low-dose aspirin may also help reduce burning pain in your feet or hands. Polycythemia vera. Phlebotomy, bloodletting a. in which a predetermined amount of blood, usually half a litre, is removed and replaced with a predetermined amount of intravenous saline solution b. which is used in the treatment of primary polycythemia. Polycythemia Vera is an uncommon myeloproliferative disease that can have hematologic and surgical implications. Bookshelf Umbrella organizations provide a range of services for patients, families, and disease-specific organizations. Transformation to myelodysplasia and acute leukemia yields a poor prognosis. There are currently no means for preventing transformation into myelofibrosis or acute leukemia/myelodysplastic syndrome, but there are known agents to avoid that can increase this risk.[17]. Mayo Clinic does not endorse companies or products. It affects 1 to 2 persons per 100,000, it has a prevalence of 22 persons per 100,000. Polycythemia vera-associated complications: Pathogenesis, clinical manifestations, and effects on outcomes. Pulmonary artery stiffness (PAS) is a relatively new noninvasive echocardiographic index developed to evaluate the structural features and functions of the pulmonary vascular bed. There is a problem with Remember, it is okay to decide not to participate in research. https://www.uptodate.com/contents/search. It's the same procedure used for donating blood. Elsevier; 2020. https://www.clinicalkey.com. 1130-1155. Take a family member or friend along, if possible, to help you remember the information you're given. If a blood clot occurs in the veins deep in the arms and the legs, it is known as deep vein thrombosis (DVT). In general, most of these blood disorders can be broken down into two basic categories based on the patients coagulation phenotype: Hypocoagulable (hemorrhagic) and Hypercoagulable (thrombotic) states [1]. 399 patients will be enrolled and randomly assigned to either pacritinib or the current standard of care. Michiels JJ. Make a donation. UMLSVocabulary Standards and Mappings Downloads, Access aggregated data from Orphanet at Orphadata, National Center for Biotechnology Information's, Newborn Screening Coding and Terminology Guide, Improving newborn screening laboratory test ordering and result reporting using health information exchange, Health Literacy Online: A Guide for Simplifying the User Experience, U.S. Department of Health & Human Services, National Center for Advancing Translation Sciences, Ways to connect to others and share personal stories, Latest treatment and research information, Lists of specialistsor specialty centers, Discuss the clinical study with a trusted medical provider before enrolling, Review the "Study Description," which discusses the purpose of the study, and"Eligibility Criteria," whichlists who can and cannot participate in the study, Work with the research coordinator to review the written informed consent, including the risks and benefits of the study, Inquire about the specific treatments and procedures, location of the study, number of visits, and time obligation, Determine whether health insurance is required and whetherthere are costs to the participant for the medical care, travel, and lodging, Ask questions. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. This condition can cause a number of symptoms and complications. Patient also complains pain in relation to right back tooth region for 2 weeks. This is an open access article distributed under the terms of the, Symptoms may start to appearat any time in life. Conditions where the body makes too many of these cells are known as myeloproliferative neoplasms. Total red blood cell mass more than or equal to 36 mL/kg in males or more than or equal to 32 mL/kg in females, Arterial oxygen saturation more than or equal to 92%, Platelets of more than 400,000/microliter, White blood cell count more than 12,000/microliter, Leukocyte alkaline phosphatase (ALP) more than 100 U/L, Serum vitamin B12 more than 900 pg/mL or binding capacity more than 2200 pg/mL, Hemoglobin (Hgb) more than 16.5 g/dL or hematocrit (Hct) more than 49% in men, Hgb more than 16 g/dL or Hct more than 48% in women; or red blood cell mass more than 25% above mean normal predicted, Bone marrow biopsy showing hypercellularity for age with trilineage growth (panmyelosis) including prominent erythroid, granulocytic, and megakaryocytic proliferation with pleomorphic, mature megakaryocytes (differences in size), Serum erythropoietin level below the reference range for normal. Avoid hot tubs, heated whirlpools, and hot showers or baths. This content does not have an English version. permits unrestricted use, distribution, and build upon your work non-commercially. Tefferi A, Spivak JL. More-specific symptoms of polycythemia vera include: Make an appointment with your doctor if you have signs or symptoms of polycythemia vera. National Heart, Lung, and Blood Institute. Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, Bloomfield CD, Cazzola M, Vardiman JW. The disease is not caused by dietary factors, and it cannot be reversed or managed with any specific diet. FOIA Polycythemia vera is rare. Your mileage may vary. 1990 Jan;34(1):79-90. Controversies in the prevention of infective endocarditis related to dental procedures. 1133- Budapest. Berlin NI. other information we have about you. Describe the presentation of polycythemia vera. Polycythemia vera, essential thrombocythemia, and primary myelofibrosis. At the time of diagnosis, 20% of patients have cytogenetic abnormalities, increasing to more than 80% for those with more than 10 years of follow-up care. PV occurs more frequently in men than it does in women. It is, therefore, important to have frequent follow up with a hematologist for close monitoring and treatment to lower these risks. Br J Haematol 2016;172:786-93, Lee S, Ma W, Zhang X, et al. This content does not have an Arabic version. Higher dose aspirin (more than 100 mg/day) is associated with an increased risk of bleeding, and 900 mg daily is associated with a high rate of gastrointestinal bleeding.[25][19][26]. No part of this content may be reproduced or transmitted in any form or by any means as per the standard guidelines of fair use
Sarnia Murders 2021,
Did St Luke Carve A Statue Of Mary,
Danny Heinrich Family,
Nancy Benoit Broken Back,
Articles P