Thrombocytosis Flashcards
REACTIVE Thrombocytosis is sitmulated by the overproduction of _____ _____ or _____
Stimulated by the overproduction of PRO-INFLAMMATORY CYTOKINES or TPO
AUTONOMOUS thrombocytosis is crowth factor and cytokines independent but due to an over production of ___ by _____ ______
Overproduction of platelets by clinical/neoplasticism megakaryocytes.
Autonomous thrombocytosis should be considered in patients with chronic thrombocytosis, normal iron stores and an intact spleen.
Symptoms associated with an elevated platelet count that are commonly associated with autonomous thrombocytosis
Vasomotor symptoms (headache, visual symptoms, acral dysesthesia)
Thrombosis
Excessive bleeding
3 broad causes of thrombocytosis
- Reactive or secondary —- associated with other medical conditions
- Autonomous or primary— due to megakaryocytes overproduction
- Spurious
Causes of spurious thrombocytosis (lab artifact)
- cryoglobulinemia, RBC fragments from severe hemolysis, burns.
- erroneously counted as platelet by automated cell counters
Confirm true thrombocytosis with -repeat CBC and peripheral blood smear
Low serum ferritin would indicate ____ thrombocytosis
Reactive thrombocytosis to iron deficiency.
The presence of Howell-Jolly bodies, target cells and abnormal RBC morphology suggesting reduced or absen ____ function
Splenic function
Dohle bodies or toxic granulation presence would indicate ____ thrombocytosis
qReactive thrombocytosis to an infection
An elevated crp, esr, ferritin and fibrinogen suggest an ___ state, and indicates that the observed thrombocytosis (clotting) is ____
An elevated crp, esr, ferritin and fibrinogen suggest an INFLAMMATORY state, and indicates that the observed thrombocytosis (clotting) is REACTIVE
MOST COMMON ESENTIAL thrombocythemia that can cause thrombocytosis
Diagnosis of exclusion: essential thrombocythemia.
May be associated with acquired VWD due to increased removal of VWF multiverses caused by adsorption to platelets.
Clonal marker for ET
JAK2 V617 or NO evidence of reactive thrombocytosis
Autonomous thrombocytosis causes
essential thrombocythemia
- polycythemia vera
- chronic myeloid nous leukaemia
- primary myelofibrosis
- melodyplastic syndrome
A person has super high platelet count and a bone marrow biopsy showing megakaryocytic proliferation. There is a clinical marker JAK2 present. What’re you suspecting?
Essential thrombocythemia. Basically a disease the cause PLATELETTS to be formed at a high rate.
Older age is more common.splenomegaly may be seen
General management for ET
Reduce thrombotic risk factors.
- ASA daily
Platelet lowering agents
- hydroxyurea, interferon.
Management of acute complications
-thrombosis- anticoagulation.
Bleeding— consider platelet transfusion, DDVAP or VWF concentrates.
Polycythemia Vera vs essential thrombocythemia
In PV, there is an increase in ALL BONE MARROW PRODUCTS— often associated with thrombocytosis and leukocytes.
ET only has platelet increase but not the other cells.
Both have JAK2 presence.
Polycythemia Vera and Essential thrombocythemia cause an increase in bone marrow products. Soon, the bone marrow can “lose steam,” producing a condition where fibrotic tissue presence starts to increased. This is called ___ ___< and is characterized by:
Primary myelofibrosis. Characterized by anemia, leukoerythroblastic blood smear, thrombocytosis or thrombocytoPENIA, splenomegaly, and hepatomegaly (platelets can be high or low depending on how fibrotic)
- you’d see a lot of collagen fibres in the bone marrow.
NOTE:
— Reactive causes are most common and are cytokine or growth factor
driven
– Autonomous causes are more commonly associated with symptoms as
a result of the elevated platelet count and are due to platelet
overproduction by clonal/neoplastic megakaryocytes
A comprehensive history and physical exam is required to distinguish between reactive and autonomous causes.
