Thrombocytosis: Difference between revisions
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===Autonomous thrombocytosis (AT)<ref>Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.</ref>=== | ===Autonomous thrombocytosis (AT)<ref>Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.</ref>=== | ||
*Accounts for 15% of cases | *Accounts for 15% of cases | ||
*A primary problem that results from [[myeloproliferative disorders]] or [[myelodysplastic | *A primary problem that results from [[myeloproliferative disorders]] or [[myelodysplastic syndrome]]s, such as essential [[thrombocytopenia]] or [[polycythemia vera]]. | ||
*Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis. | *Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis. | ||
*There are no diagnostic studies to differentiate RT versus AT. | *There are no diagnostic studies to differentiate RT versus AT. | ||
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==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>== | ==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>== | ||
===Reactive thrombocytosis=== | ===Reactive thrombocytosis=== | ||
* Acute blood loss | * Acute [[hemorrhage|blood loss]] | ||
* Acute hemolytic anemia | * Acute [[hemolytic anemia]] | ||
* Iron deficiency anemia | * Iron deficiency [[anemia]] | ||
* Treatment of [[vitamin B12 deficiency]] | * Treatment of [[vitamin B12 deficiency]] | ||
*Rebound effect after thrombocytopenia treatment | * Rebound effect after [[thrombocytopenia]] treatment | ||
* Metastatic cancer | * Metastatic cancer | ||
* [[Lymphoma]] | * [[Lymphoma]] | ||
| Line 42: | Line 42: | ||
* Thermal [[burn]] | * Thermal [[burn]] | ||
* [[MI]] | * [[MI]] | ||
* Severe trauma | * Severe [[trauma]] | ||
* [[Acute pancreatitis]] | * [[Acute pancreatitis]] | ||
* Post-surgery, especially splenectomy | * Post-surgery, especially [[splenectomy]] | ||
* CABG | * CABG | ||
* [[TB]] | * [[TB]] | ||
* Acute bacterial/viral infections | * Acute [[bacterial disease|bacterial]]/[[viruses|viral]] infections | ||
* Asplenia | * [[asplenic patient|Asplenia]] | ||
* [[Allergic reaction]] | * [[Allergic reaction]] | ||
* Medication reactions: vincristine, epinephrine, glucocorticoids, IL-1B, ATRA, thrombopoietin, LMWH | * Medication reactions: vincristine, [[epinephrine]], [[glucocorticoids]], IL-1B, ATRA, thrombopoietin, [[LMWH]]<ref>uptodate</ref> | ||
===Autonomous thrombocytosis=== | ===Autonomous thrombocytosis=== | ||
* Essential | * [[Essential thrombocytosis]] | ||
* [[Polycythemia vera]] | * [[Polycythemia vera]] | ||
* Mixed myelodysplastic and/or myeloproliferative syndrome | * Mixed [[myelodysplastic syndrome|myelodysplastic]] and/or [[myeloproliferative disorders|myeloproliferative syndrome]] | ||
===Spurious (false) thrombocytosis=== | ===Spurious (false) thrombocytosis=== | ||
Latest revision as of 23:46, 30 September 2019
Background
- Defined as a platelet count >450,000/microL.
Reactive thrombocytosis (RT)
- Most common cause of thrombocytosis, accounting for 85% of cases.
- A reaction to another process, such as inflammation, infection, cancer, or iron deficiency.
- Rarely causes complications even with extremely elevated platelet counts (>1,000,000/microL).
Autonomous thrombocytosis (AT)[1]
- Accounts for 15% of cases
- A primary problem that results from myeloproliferative disorders or myelodysplastic syndromes, such as essential thrombocytopenia or polycythemia vera.
- Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis.
- There are no diagnostic studies to differentiate RT versus AT.
Clinical Features[2]
Generally asymptomatic and found on routine lab testing; complications are typically from AT disorders
- Thrombosis (leading cause of morbidity and mortality)
- Arteries (more common)
- Venous system
- Serious bleeding (less common)
- Generally in the nasal and bucchal mucosa and the GI tract
- Vasomotor symptoms (due to microvascular disturbances)
- Headache, lightheadedness, syncope, acral paresthesia, atypical chest pain, livedo reticularis, erythromelalgia, and transient visual disturbances
Differential Diagnosis[3]
Reactive thrombocytosis
- Acute blood loss
- Acute hemolytic anemia
- Iron deficiency anemia
- Treatment of vitamin B12 deficiency
- Rebound effect after thrombocytopenia treatment
- Metastatic cancer
- Lymphoma
- Rheumatologic disorders
- IBD
- Celiac disease
- Kawasaki disease
- Nephrotic syndrome
- POEMS syndrome
- Thermal burn
- MI
- Severe trauma
- Acute pancreatitis
- Post-surgery, especially splenectomy
- CABG
- TB
- Acute bacterial/viral infections
- Asplenia
- Allergic reaction
- Medication reactions: vincristine, epinephrine, glucocorticoids, IL-1B, ATRA, thrombopoietin, LMWH[4]
Autonomous thrombocytosis
Spurious (false) thrombocytosis
- Mixed cryoglobulinemia
- Cytoplasmic fragments
- Bacteremia
Evaluation
Workup
- Labs
- CBC, ESR, CRP, iron studies, LDH
- CXR
- Fecal occult blood test
Diagnosis
- platelet count >450,000/microL.
Management
Reactive thrombocytosis
- Treat underlying disease.
Autonomous thrombocytosis
Asymptomatic
- 81mg ASA PO daily.
- If high risk for thrombotic event (>60 yrs, history of thrombosis, or known JAK2 mutation), consider 15mg/kg hydroxyurea PO daily. Consult if available.
- Second line agents include interferon-α, anagrelide, and pipobroman.
Thrombosis due to AT
- Anticoagulation with LMWH.
- 81mg ASA PO daily.
- Consult heme/onc
- Consider 3-5 million U interferon-α SQ daily if <40 years old. 15mg/kg hydroxyurea PO daily if >40 years old. Goal platelet count <400,000/microL.
- Platelet apheresis if platelet count >800,000/microL.
Bleeding due to AT
- Discontinue antiplatelet medications.
- Consult.
- Consider 3-5 million U interferon-α SQ daily if <40 years old. 15mg/kg hydroxyurea PO daily if >40 years old. Goal platelet count <400,000/microL.[5]
Disposition
Reactive thrombocytosis
- Disposition is based on underlying disorder.
Autonomous thrombocytosis
- If asymptomatic, consider outpatient treatment with close follow up.
- If thrombosis or bleeding complications, should be admitted for stabilization and further work up.
External Links
References
- ↑ Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.
- ↑ Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.
- ↑ Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.
- ↑ uptodate
- ↑ Bleeker, "Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies," Thrombosis. 2011; 2011: 536062. Published online 2011 Jun 8. doi:10.1155/2011/536062.