Thrombocytosis

Question 1

What is thrombocytosis?

Answer 1

Elevated platelet count (>450,000) in peripheral blood

Question 2

What are two causes of thrombocytosis?

Answer 2

Reactive thrombocytosis (overproduction of platelets) or clonal thrombocytosis (clonal expression of megakaryocytes). Reactive more common than clonal

Question 3

What are some clinical presentations of thrombocytosis?

Answer 3

HA, blurry vision, dizziness, atypical CP, limp dysesthesia, erthromelalgia thrombotic and bleeding complications can occur, splenomegal, coexisting leukocytosis and erythrocytosis

Question 4

What is the standard workup for thrombocytosis?

Answer 4

CBC w/ peripheral smear, serum ferritin, CRP and ESR, Philadelphia chrom, serum EPO assay, JAK2 mutation analysis, bone marrow chromosome analysis.

Question 5

Which thrombocytosis is rarely associated with bleeding and generally doesn’t require specific therapy?

Answer 5

Reactive thrombocytosis

Question 6

Treatment for acute thrombocytosis?

Answer 6

Vasomotor sxs: ASA, bleeding: D/C NSAIDs and ASA, immediate platelet apheresis w/ a platelet lowering agent in Von Willebrands. Thrombosis: plt >800, platelet apheresis + platelet lowering agent, anticoag therapy 3-9 months

Question 7

Treatment for chronic thrombocytosis?

Answer 7

Smoking cessation and obesity management. ASA 81mg, cytoreductive therapy (hydroxyurea + ASA)