Thrombocytosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Synonyms and keywords: Platelet count raised; thrombocythemia
Overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Thrombocytosis is the presence of high platelet counts in the blood, and can be either reactive or primary (also termed essential and caused by a myeloproliferative disease). Although often symptomless (particularly when it is a secondary reaction), it can predispose to thrombosis in some patients.
- Definition
- 95% of the population will have a platelet count between 100,000 and 450,000 per mm³. Thrombocytosis is defined as >500,000. Extreme thrombocytosis is defined as >1,000,000. Generally, a normal platelet count ranges from 150,000 and 450,000 per mm³. These limits, however, are determined by the 2.5th lower and upper percentile, and a deviation does not necessary imply any form of disease. Nevertheless, counts over 750,000 (and especially over a million) are considered serious enough to warrant investigation and intervention.
References
Historical Perspective
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Classification
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Pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
Pathophysiology
Thrombocytosis is either reactive or autonomous. In one study of 91 patients with platelet count >600,000, 70% were reactive and 22% autonomous. In 280 patients with platelet count >1,000,000 82% were reactive and 14% were autonomous. 8% had both. Among reactive causes of thrombocytosis, infection (30%), Post-surgical (15%), Both (30%), Malignancy (10%), Post splenectomy (10%) and acute blood loss/iron deficiency (10%) are the most common causes.
Autonomous causes of thrombocytosis include Essential Thrombocytosis, Chronic Myelogenous Leukemia (CML), Polycythemia Vera, Agnogenic Myeloid Metaplasia and Myelodysplasia. The degree of thrombocytosis does not help determine whether the thrombocytosis is reactive or not.
References
Causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]
Overview
Causes
Increase platelet counts can be due to a number of disease processes:
- Essential (Primary)
- Essential thrombocytosis (a form of myeloproliferative disease)
- Other myeloproliferative disorders such as chronic myelogenous leukemia, polycythemia vera, myelofibrosis
- Reactive (Secondary)
- Inflammation
- Surgery (which leads to an inflammatory state)
- Hyposplenism (decreased breakdown due to decreased function of the spleen)
- Hemorrhage and/or iron deficiency
- Drud Side Effect- Aztreonam, Ceftazidime, Ibuprofen
References
Differentiating Thrombocytosis from other Diseases
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Thrombocytosis Differential Diagnosis
Differentiating the diseases that can cause thrombocytosis :
| Category | Condition | Etiology | Mechanism | Inherited | Acquried | Clinical manifestations | Para−clinical findings | Gold standard | Associated findings | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Demography | History | Symptoms | Signs | ||||||||||||||||||||||||
| Lab Findings | Imaging | ||||||||||||||||||||||||||
| Fever | Appearance | Bleeding | BP | Splenomegaly | Jaundice | Other | CBC | PBS | Bone marrow exam | PT | PTT | ||||||||||||||||
| Increased megakaryocyte proliferation | Accelerated platelet release | Reduced platelet turnover | Plt | HB | WBC | ||||||||||||||||||||||
| Autonomous thrombocytosis | Hematologic malignancies | Essential thrombocythemia[1] |
|
+ | – | – | – | + | Mean age >60 years old, female > male |
|
± |
|
+ | Nl | + | – | ↑↑ | ↑ | ↑ |
|
|
Nl | Nl |
|
Bone marrow biopsy |
| |
| Polycythemia vera[2] |
|
+ | – | – | – | + | Mean age >60 years old |
|
– |
|
± | Nl | + | – | ↑ | ↑↑ | ↑ |
|
|
↑ | ↑ |
|
Bone marrow biopsy |
| |||
| Primary myelofibrosis[3] |
|
+ | – | – | – | + | Mean age >60 years old, male> female |
|
– | + | Nl | + | + |
|
↑/↓ | ↓ | ↓ |
|
|
↑ | ↑ | Bone marrow biopsy |
| ||||
| Chronic myeloid leukemia[4] |
|
+ | – | – | – | + | Mean age >50 years old, male> female | History of exposure to: | + | + | Nl | + | – |
|
↑ | ↓ | ↑ |
|
|
↑ | ↑ |
|
Bone marrow biopsy |
| |||
| Acute myeloid leukemia[5] |
|
+ | – | – | – | + | Median age of 63 years old |
|
+ | + | Nl | + | + |
|
↑/↓ | ↓ | ↑/↓ |
|
↑ | ↑ | NA | Bone marrow examination + clinical manifestation |
| ||||
| Myelodysplastic syndromes[6] |
|
+ | – | – | ± | + | Elderly | Exposure to: | ± | + | Nl | + | + | ↑/↓ | ↓ | ↓ |
|
|
Nl | Nl | NA | Bone marrow examination + clinical manifestation |
| ||||
| Condition | Etiology | Increased megakaryocyte proliferation | Accelerated platelet release | Reduced platelet turnover | Inherited | Acquried | Demography | History | Fever | Appearance | Bleeding | BP | Splenomegaly | Jaundice | Other signs | Plt | HB | WBC | PBS | Bone marrow exam | PT | PTT | Imaging | Gold standard | Associated findings | ||
| Familial thrombocytosis[7][8] |
|
+ | – | – | + | – | Rare familial disease, middle age male and female |
|
– |
|
– | Nl | – | – | – | ↑ | Nl | Nl |
|
|
Nl | Nl | NA | Genetic study |
| ||
| Reactive thrombocytosis | Anemia/ |
|
+ | – | – | – | + | Any |
|
– | + | Nl to ↓ | – | – | Depends on the etilogy | ↑ | ↓ | Nl |
|
|
Nl | Nl | NA | Clinical manifestation |
| ||
| Infection | Chronic infections |
|
+ | + | – | – | + | Any |
|
+ | ± | Nl to ↓ | – | ± | Depends on the etilogy | ↑ | ↓ | ↑ |
|
|
Nl | Nl |
|
Culture | Depends on the etilogy | ||
| Tuberculosis |
|
+ | + | – | – | + | Any |
|
+ |
|
– | Nl | – | – | ↑ | Nl | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation+ culture | ||||
| Acute bacterial and viral infections |
|
+ | + | – | – | + | Any |
|
+ |
|
– | Nl | – | – | Depends on the etilogy | ↑ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation+ culture |
| |||
| Inflammation | Vasculitides[10] |
|
+ | + | – | ± | + | Any |
|
+ |
|
+ | Nl | – | – | ↑ | Nl to ↓ | ↑ |
|
|
Nl to ↑ | Nl to ↑ |
|
Clinical manifestation+ culture |
| ||
| Acute pancreatitis |
|
+ | + | – | – | + | Any | + |
|
– | Nl to ↓ | – | + | ↑ | Nl to ↓ | ↑ |
|
|
Nl to ↑ | Nl to ↑ |
|
Clinical manifestation |
| ||||
| Malignancy[11] |
|
+ | + | – | ± | ± | Any |
|
+ |
|
– | Nl to ↓ | Depends on the type | – |
|
↑ | Nl to ↓ | ↑ |
|
|
Nl to ↑ | Nl to ↑ |
|
Biopsy |
| ||
| Condition | Etiology | Increased megakaryocyte proliferation | Accelerated platelet release | Reduced platelet turnover | Inherited | Acquried | Demography | History | Fever | Appearance | Bleeding | BP | Splenomegaly | Jaundice | Other signs | Plt | HB | WBC | PBS | Bone marrow exam | PT | PTT | Imaging | Gold standard | Associated findings | ||
| Tissue damage | Thermal burns[12] |
|
– | + | – | – | + | Any |
|
+ |
|
± | Nl to ↓ | – | ± | ↑ | Nl to ↓ | ↑ |
|
|
Nl to ↑ | Nl to ↑ |
|
Clinical manifestation | |||
| Trauma[13] |
|
– | + | – | – | + | Any |
|
± |
|
± | Nl to ↓ | – | – | ↑ | Nl to ↓ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation |
| |||
| Myocardial infarction[14] |
|
– | + | – | – | + | Elderly | ± |
|
– | Nl to ↓ | – | – | ↑ | Nl to ↓ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation + enzymes elevation |
| ||||
| Medication[15] | Vincristine[16] |
|
– | + | – | – | + | Any |
|
– |
|
– | Nl | + | – | ↑ | Nl to ↓ | ↑ |
|
|
Nl to ↑ | Nl to ↑ |
|
Clinical manifestation + history of drug consumption | |||
| Epinephrine[17] |
|
+ | + | – | – | + | Any | – |
|
– | Nl to ↓ | – | – | ↑ | ↑ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation + history of drug consumption |
| ||||
| Glucocorticoids[18] |
|
+ | + | – | – | + | Any | + |
|
Nl to ↓ | – | – | ↑ | Nl to ↓ | ↑ |
|
|
Nl to ↑ | Nl to ↑ |
|
Clinical manifestation + history of drug consumption |
| |||||
| Antibiotics[19] |
|
+ | + | – | – | + | Any | + | Nl | ± | Nl | – | – |
|
↑ | Nl | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation + history of drug consumption |
| |||
| Thrombopoietin[20][21] |
|
+ | – | – | – | + | Any | + |
|
– | Nl to ↑ | – | – |
|
↑ | ↑ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation + history of drug consumption |
| |||
| Condition | Etiology | Increased megakaryocyte proliferation | Accelerated platelet release | Reduced platelet turnover | Inherited | Acquried | Demography | History | Fever | Appearance | Bleeding | BP | Splenomegaly | Jaundice | Other signs | Plt | HB | WBC | PBS | Bone marrow exam | PT | PTT | Imaging | Gold standard | Associated findings | ||
| Other | Post-splenectomy or functional asplenia[22] |
|
– | – | + | – | + | Any |
|
± |
|
+ | Nl | Asplenia | – | – | ↑ | ↓ | ↑ |
|
|
Nl | Nl | Clinical manifestation |
| ||
| Allergic reactions[23] |
|
+ | + | – | – | + | Any | – |
|
– | Nl to ↓ | – | – | ↑ | ↑ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation |
| ||||
| Exercise[24] |
|
+ | + | – | – | + | Athlete |
|
– | Normal | – | Nl | – | – | NA | ↑ | ↑ | ↑ |
|
|
Nl | Nl |
|
Clinical manifestation | NA | ||
| Pseudothrombocytosis | Mixed cryoglobulinemia[25] |
|
– | – | – | – | – | Any | – |
|
– | Nl | – | – |
|
↑ | Nl to ↓ | ↑ |
|
Nl | Nl | Nl | NA | Skin biopsy | |||
| Cytoplasmic fragments[26] |
|
– | – | – | – | – | Any | NA | – | Normal | – | Nl | – | – | NA | ↑ | Nl | Nl |
|
Nl | Nl | Nl | Nl | Repeat | NA | ||
References
- ↑ Brière, Jean B (2007). Orphanet Journal of Rare Diseases. 2 (1): 3. doi:10.1186/1750-1172-2-3. ISSN 1750-1172. Missing or empty
|title=(help) - ↑ Arber, D. A.; Orazi, A.; Hasserjian, R.; Thiele, J.; Borowitz, M. J.; Le Beau, M. M.; Bloomfield, C. D.; Cazzola, M.; Vardiman, J. W. (2016). “The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia”. Blood. 127 (20): 2391–2405. doi:10.1182/blood-2016-03-643544. ISSN 0006-4971.
- ↑ Tefferi, Ayalew; Lasho, Terra L.; Jimma, Thitina; Finke, Christy M.; Gangat, Naseema; Vaidya, Rakhee; Begna, Kebede H.; Al-Kali, Aref; Ketterling, Rhett P.; Hanson, Curtis A.; Pardanani, Animesh (2012). “One Thousand Patients With Primary Myelofibrosis: The Mayo Clinic Experience”. Mayo Clinic Proceedings. 87 (1): 25–33. doi:10.1016/j.mayocp.2011.11.001. ISSN 0025-6196.
- ↑ Thompson, Philip A.; Kantarjian, Hagop M.; Cortes, Jorge E. (2015). “Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015”. Mayo Clinic Proceedings. 90 (10): 1440–1454. doi:10.1016/j.mayocp.2015.08.010. ISSN 0025-6196.
- ↑ Rose-Inman, Hayley; Kuehl, Damon (2014). “Acute Leukemia”. Emergency Medicine Clinics of North America. 32 (3): 579–596. doi:10.1016/j.emc.2014.04.004. ISSN 0733-8627.
- ↑ Natelson, Ethan A.; Pyatt, David (2013). “Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog”. Advances in Hematology. 2013: 1–11. doi:10.1155/2013/309637. ISSN 1687-9104.
- ↑ Ding, J. (2004). “Familial essential thrombocythemia associated with a dominant-positive activating mutation of the c-MPL gene, which encodes for the receptor for thrombopoietin”. Blood. 103 (11): 4198–4200. doi:10.1182/blood-2003-10-3471. ISSN 0006-4971.
- ↑ Wiestner, A.; Padosch, S. A.; Ghilardi, N.; Cesar, J. M.; Odriozola, J.; Shapiro, A.; Skoda, R. C. (2000). “Hereditary thrombocythaemia is a genetically heterogeneous disorder: exclusion of TPO and MPL in two families with hereditary thrombocythaemia”. British Journal of Haematology. 110 (1): 104–109. doi:10.1046/j.1365-2141.2000.02169.x. ISSN 0007-1048.
- ↑ Kuter, David J. (1996). “The Physiology of Platelet Production”. Stem Cells. 14 (S1): 88–101. doi:10.1002/stem.5530140711. ISSN 1066-5099.
- ↑ Hamblin T, Oscier D (September 1978). “Polyarteritis presenting with thrombocytosis and palliated by plasma exchange”. Postgrad Med J. 54 (635): 615–7. PMC 2425233. PMID 82963.
- ↑ Yang, Chen; Jiang, Hui; Huang, Shaozhuo; Hong, Hui; Huang, Xiaowen; Wang, Xiaojie; Liao, Weixin; Wang, Xueyi; Chen, Xuewen; Jiang, Liming (2018). “The prognostic role of pretreatment thrombocytosis in gastric cancer”. Medicine. 97 (31): e11763. doi:10.1097/MD.0000000000011763. ISSN 0025-7974.
- ↑ Dinsdale, R. J.; Devi, A.; Hampson, P.; Wearn, C. M.; Bamford, A. L.; Hazeldine, J.; Bishop, J.; Ahmed, S.; Watson, C.; Lord, J. M.; Moiemen, N.; Harrison, P. (2017). “Changes in novel haematological parameters following thermal injury: A prospective observational cohort study”. Scientific Reports. 7 (1). doi:10.1038/s41598-017-03222-w. ISSN 2045-2322.
- ↑ Salim, Ali; Hadjizacharia, Pantelis; DuBose, Joseph; Kobayashi, Leslie; Inaba, Kenji; Chan, Linda S.; Margulies, Daniel R. (2009). “What is the Significance of Thrombocytosis in Patients With Trauma?”. The Journal of Trauma: Injury, Infection, and Critical Care. 66 (5): 1349–1354. doi:10.1097/TA.0b013e318191b8af. ISSN 0022-5282.
- ↑ Frye JL, Thompson DF (February 1993). “Drug-induced thrombocytosis”. J Clin Pharm Ther. 18 (1): 45–8. PMID 8473359.
- ↑ Feliu, E.; Cervantes, F.; Blade, J.; Rozman, C. (1980). “Thrombocytosis in Quiescent Chronic Granulocytic Leukaemia after Vincristine and 6-Mercaptopurine Therapy”. Acta Haematologica. 64 (4): 224–226. doi:10.1159/000207258. ISSN 0001-5792.
- ↑ Spalding A, Vaitkevicius H, Dill S, MacKenzie S, Schmaier A, Lockette W (February 1998). “Mechanism of epinephrine-induced platelet aggregation”. Hypertension. 31 (2): 603–7. PMID 9461228.
- ↑ Neel, Jennifer A.; Snyder, Laura; Grindem, Carol B. (2012). “Thrombocytosis: a retrospective study of 165 dogs”. Veterinary Clinical Pathology. 41 (2): 216–222. doi:10.1111/j.1939-165X.2012.00416.x. ISSN 0275-6382.
- ↑ Scharf RE (November 2012). “Drugs that affect platelet function”. Semin. Thromb. Hemost. 38 (8): 865–83. doi:10.1055/s-0032-1328881. PMID 23111864.
- ↑ Hitchcock IS, Kaushansky K (April 2014). “Thrombopoietin from beginning to end”. Br. J. Haematol. 165 (2): 259–68. doi:10.1111/bjh.12772. PMID 24499199.
- ↑ Teofili, Luciana; Giona, Fiorina; Martini, Maurizio; Torti, Lorenza; Cenci, Tonia; Foà, Robin; Leone, Giuseppe; Larocca, Luigi M. (2010). “Thrombopoietin Receptor Activation, Thrombopoietin Mimetic Drugs, and Hereditary Thrombocytosis: Remarks on Bone Marrow Fibrosis”. Journal of Clinical Oncology. 28 (19): e317–e318. doi:10.1200/JCO.2010.29.0387. ISSN 0732-183X.
- ↑ Vlachaki E, Kalogeridis A, Neokleous N, Perifanis V, Klonizakis F, Ioannidou E, Klonizakis I (May 2012). “Absence of JAK2V617F mutation in patients with beta-thalassemia major and thrombocytosis due to splenectomy”. Mol. Biol. Rep. 39 (5): 6101–5. doi:10.1007/s11033-011-1425-7. PMID 22203487.
- ↑ Randi ML, Rossi C, Fabris F, Zerbinati P, Girolami A (December 1995). “Atopic dermatitis and allergic diseases with thrombocytosis: a possible link”. Ann. Allergy Asthma Immunol. 75 (6 Pt 1): 530–2. PMID 8603285.
- ↑ Beck WR, Scariot PP, Gobatto CA (2014). “Primary and secondary thrombocytosis induced by exercise and environmental luminosity”. Bratisl Lek Listy. 115 (10): 607–10. PMID 25573725.
- ↑ Patel KJ, Hughes CG, Parapia LA (January 1987). “Pseudoleucocytosis and pseudothrombocytosis due to cryoglobulinaemia”. J. Clin. Pathol. 40 (1): 120–1. PMC 1140844. PMID 3818970.
- ↑ Akinci, Sema; Hacibekiroglu, Tuba; Basturk, Abdulkadir; Bakanay, Sule Mine; Guney, Tekin; Dilek, Imdat (2013). “Pseudothrombocytosis due to Microerythrocytosis: A Case of Beta Thalassemia Minor Complicated with Iron Deficiency Anemia”. Acta Haematologica. 130 (2): 61–63. doi:10.1159/000346434. ISSN 1421-9662.
Epidemiology and Demographics
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Risk Factors
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Screening
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Natural History, Complications and Prognosis
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Diagnosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | CT | Ultrasound | Other Imaging Studies | Other Diagnostic Studies
Treatment
Treatment
Medical Therapy | Surgery | Prevention | Future or Investigational Therapies | Cost Effectiveness of Therapy
Acknowledgements
Acknowledgements
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