Thrombocytosis
Aside from the hematocrit, the platelet count tends to be the second most ignored lab value that is displayed on a CBC. This is often the case because most of the time the platelet count is normal or close enough to normal - Darshak Vekaria MD
HWN Suggests
How should we manage thrombocytosis in children?
In adults, management of thrombocytosis is based on risk stratification (age over 60; thrombosis history; extreme thrombocytosis; cardiovascular risk factors; JAK2 mutation). Clearly this stratification is not that helpful in children.
As the research on children with thrombocytosis is so scant, we derive our management from the adult guidelines. In adults, those who are low risk are treated with low dose aspirin; other treatments for higher risk patients include hydroxyurea, interferon alpha, busulfan, anagrelide, and targeted therapy for JAK2 inhibitors (Ruxolitinib).
In children, there is no consensus guidelines, but some approaches have been published. The general advice…
Featured
Reactive Thrombocytosis: A Benign Entity?
Causes of thrombocytosis can be physiologic (exercise, parturition) and can also be primary/clonal (e.g., essential thrombocythemia, polycythemia vera, primary myelofibrosis, and other hematologic malignancies) as well as secondary/ reactive (due to infectious and inflammatory diseases, neoplasms, anemia, trauma, surgery, asplenia, and iron deficiency).
Thrombocytosis in the ED
In the ED, we must try to differentiate myeloproliferative/clonal thrombocytosis from secondary/reactive thrombocytosis.
Articles of Interest
Clinical relevance of thrombocytosis in primary care
Thrombocytosis is a risk marker of cancer in adults; 11.6% and 6.2% cancer incidence in males and females, respectively, is worthy of further investigation for underlying malignancy.
How I Work up the Patient with Thrombocytosis
In managing the patient with thrombocytosis, one must first distinguish reactive from primary thrombocytosis. The presence of acute or subacute infection, a connective tissue disorder, vasculitis, hemolysis, active bleeding, recent surgery, history of splenectomy, or iron deficiency anemia favors the diagnosis of reactive thrombocytosis.
Thrombocytosis (primary and secondary) | Why Is My Platelet Count High?
Good rundown....
Resources
American Society of Hematology
Thrombocytosis is defined as a platelet count exceeding 450 × 109/L in adults.1,2 This abnormality is classified as “primary thrombocytosis,” when the increase in platelets is caused by alterations targeting the hematopoietic cells, or as “secondary thrombocytosis” (also called “reactive thrombocytosis”), when the increase in platelets can be traced to an external cause, such as chronic inflammation, cancer, iron deficiency, or rebound after splenectomy.
ScienceDirect
Thrombocytosis is defined as a platelet count above 350,000 to 400,000/μL, which is the upper limit of the normal reference range. Thrombocytosis may be categorized as familial, reactive, or secondary nonclonal processes (reactive thrombocytosis [RT]), or as the manifestation of a primary myeloproliferative disorder (MPD)—usually an autonomous and clonal process.
