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Thrombocytosis

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Thrombocytosis

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Thrombocytosis or raised -Platelet count of greater than 450 x 109 also called Thrombocythaemia

Try and determine the cause – present in 1.5 to 2.2 % of 
the people aged > 40 seen in primary care REACTIVE-Overproduction of platelets- acute phase reactants More common ↑↑ cytokines due to any reason Platelet count normalizes or is expected to return to normal once the condition resolves Acute and chronic infection Haemorrhage Trauma , tissue damage Surgery Acute and chronic inflammatory conditions Rheumatological disorders Inflammatory bowel disease Coeliac disease Iron deficiency anaemia Hemolytic anaemia Post- splenectomy Solid malignancies Severe exercise Usually but not always associated with an ↑ ESR or CRP Platelets normally small with a normal mean platelet volume Blood film may show other features to indicate acute infective or inflammatory process

CLONAL-Clonal expansion of megakaryocytes Failure to regulate platelet production Myeloproloferative or myelodysplastic disorders Essential thrombocythaemia or 
essential thrombocytosis Chronic myeloid leukaemia – CML Polycythemia vera Primary myelofibrosis

Risk of myeloproliferative disorders is increased if presentation is with ↑ platelets along with erythrocytosis , leukocytosis , thrombosis or splenomegaly

history-Recent trauma or surgery Splenectomy Symptoms of infection or inflammation Bleeding , thrombosis or iron deficiency Any haematological diagnosis Constitutional symptoms – r/o malignancy
○ weight loss
○ fatigue
○ systemic complains Medications

Complications –Vasomotor symptoms
Headache , visual symptoms , light-headedness ,
 atypical chest pain , syncope , erythromelalgia ( redness & pain of
 the digits of hand /feet ) , acrocyanosis 
and visual changes Thrombosis Bleeding complications- from skin , gums or nose and
 blockage of arteries ( particularyl extreme thrombocytosis ) Splenomegaly 
Liver may also be enlarged

Risk of cancer and 
thrombocytosis- BJGP 2017 
the incidence of cancer rose 
with age & with a higher 
platelet count & atleast 1/3rd of patients with lung and colorectal cancer with pre-disgnosis thrombocytosis had no other symptoms indicative of 
malignancy

Tests-FBC , Peripheral blood film , Ferritin Inflammatory markers as CRP , ESR , Plasma fibrinogen Reticulocyte count- r/o hemolytic anaemia Bone marrow aspirate or BM Trephine biopsy Molecular genetics

Reactive-Self limited Treat the underlying condition Little excess associated thrombotic risk Treat iron deficiency if present No antiplatelet therapy recommended

 

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