Occurence, etiology, and clinical significance of extreme thrombocytosis: A study of 280 cases

doi:10.1016/0002-9343(94)90150-3

The American Journal of Medicine

Volume 96, Issue 3, March 1994, Pages 247-253

https://doi.org/10.1016/0002-9343(94)90150-3 Get rights and content

Abstract

purpose: To determine the etiology and to evaluate the clinical consequences of an extremely elevated platelet count.

patients and methods: A review of the medical records was performed on all patients encountered during a 5 1/2-year period who had at least one platelet count of 1,000 × 10⁹/L or greater.

results: Of the total of 280 patients with extreme thrombocytosis (EXT), 231 (82%) had reactive thrombocytosis (RT), 38 (14%) had a myeloproliferative disorder (MPD), and 11 (4%) had cases of uncertain etiology. RT was more common than MPD in all age groups except those in the eighth decade and older. Symptoms of bleeding and/or vaso-occlusive phenomena were noted in association with EXT in 21 (56%) of the MPD patients but in only 10 (4%) of the RT patients. Treatment to lower the platelet count and/or inhibit platelet function was employed in 36 MPD patients and 23 RT patients. Eight patients with MPD and 34 with RT are known to have died, but no patient in either group is known to have died of a thrombotic or bleeding event when the platelet count was greater than or equal to 1,000 × 10⁹/L.

conclusions: Platelet counts greater than or equal to 1,000 × 10⁹/L should not be considered rare events in the general, acute-care hospital population, and usually represent a reactive phenomenon.

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Cited by (158)

Extreme thrombocytosis with severe anemia and infection in a Sudanese patient: A case report
2022, Annals of Medicine and Surgery
Secondary thrombocytosis, also known as reactive thrombocytosis, is defined as an abnormal increase in platelet count as a result of another underlying medical or surgical condition. Once the medical cause of reactive thrombocytosis was determined, it could be treated. In this case, supportive treatment with no iron supplements for anemia and infection improved the case condition rapidly.
we report a 20 years old Sudanese female who presented with high-grade fever, right iliac fossa pain, hyper pigmented macules on the tongue and a past history of undiagnosed anemia. Laboratory results showed platelets = 1007 × 10^3/μl, hemoglobin = 3.5 g/dl with low MCV, total WBC was also high = 14.9 × 10^3/μl. Peripheral blood picture showed anisocytosis and poikilocytosis, microcytic hypochromic RBCs associated with target cells, pencil cells, teardrops cells and polychromies cells and with leukocytosis and very high platelets in the film. Abdominal ultrasound showed evidence of pelvic inflammatory disease. After receiving supportive treatment, antibiotics and 3 units of blood the patient showed remarkable improvement and reduction in platelet count.
We discuss the mechanism of the reactive thrombocytosis state and the variable treatment options when accompanied with iron deficiency anemia.
Reactive thrombocytosis with extreme platelet count should always be considered in patients presented with severe iron deficiency anemia and infection. In this case report the high platelet count was reversed successfully after commencing antibiotics and blood transfusion although of the poor patient compliance and the poor investigations were obtained from the patient.
Etiologies of Extreme Thrombocytosis: A Contemporary Series
2019, Mayo Clinic Proceedings
Citation Excerpt :
and (2) What should be the extent of evaluation to rule out such a possibility? These questions were not addressed by previous studies.3,4,6 In our study, the discovery of a new malignancy was relatively uncommon (∼10%) and most were in the outpatient setting with an abnormal platelet count as the isolated finding—features highly suggestive of myeloid neoplasms.
To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy.
We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×10⁹/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts.
A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT.
Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.
Reactive thrombocytosis in acute infectious diseases: Prevalence, characteristics and timing
2019, European Journal of Internal Medicine
Reactive thrombocytosis is known to occur in infectious, inflammatory and neoplastic diseases. However, the characteristics of its association with acute infections (ID) has not been systematically studied.
A department of internal medicine in a general teaching hospital.
Retrospective chart review of admitted patients with a confirmed diagnosis of community-acquired pneumonia (CAP), urinary tract infection (UTI) or skin and soft tissue infection (SSTI). Key clinical and laboratory data were retrieved and patients with platelet counts >400 × 10⁹/L who had no alternative cause of thrombocytosis were studied longitudinally and compared to patients with acute infections who had no thrombocytosis.
Thirty two of 421 patients with acute infections (ID) had infection-associated thrombocytosis (7.6%): 11/125 patients with CAP (8.8%), 13/205 patients with UTI (6.3%) and 8/91 (8.8%) patients with SSTI. Their median ages (77–78 years), gender (48% males), admission temperature, Hb, and WBC were not significantly different from ID patients without thrombocytosis. However, patients with thrombocytosis had longer hospital stays (P = 0.001), more bacteremias (P = 0.048) and in 4/32 (12/5% vs. 2%) significantly increased combined mortality or suppurative complications (P = 0.0006). The ESR (median 70 vs. 40 mm/h, P = 0.000) and CRP (median 214 vs. 114 mg/dL, P < 0.0001) were found to be increased in ID-associated thrombocytosis patients, similarly for each ID. Platelets increase was already found on admission in 18 patients (56%), was mild in most cases (median 492.5 × 10⁹/L, range 401–917 × 10⁹/L) and resolved after recovery in all survivors. The median time to thrombocytosis was 1 day in patients with CAP, 4 days in UTI and 7.5 days in SSTI. No thrombotic complications were found.
Approximately 8% of patients with acute ID examined had thrombocytosis which was mostly mild, transient, and not usually indicative of an infectious complication. However, these patients had enhanced acute-phase response, increased length of hospital stay, more bacteremia and increased mortality/suppurative complications albeit affecting a minority of patients.
Thrombocytosis and essential thrombocythemia
2019, Platelets
Management of essential thrombocythemia (ET) starts with confirming the accuracy of the diagnosis and excluding congenital and reactive thrombocytosis and myeloid neoplasms which might mimic ET. Diagnosis acording to WHO criteria requires a platelet count of ≥450×10⁹/L, presence of one of the three “driver” mutations, including JAK2, CALR, and MPL or in their absence the exclusion of other causes of thrombocytosis, and bone marrow histology. Most patients with ET have a normal life expectancy with low risk of leukemic transformation or fibrotic progression. Observation alone remains a viable treatment option for “very low-risk” patients while all other patients might benefit from aspirin therapy, in a once- or twice-daily schedule. In addition, cytoreductive treatment is recommended in patients with thrombosis history, and drugs of choice in this regard are hydroxyurea and pegylated interferon-α. There is currently no evidence to support the need for JAK inhibitor therapy in the majority of patients with ET, regardless of whether or not they are hydroxyurea-refractory
Serum or plasma, what is the difference? Investigations to facilitate the sample material selection decision making process for metabolomics studies and beyond
2018, Analytica Chimica Acta
Citation Excerpt :
Based on our data achieved in healthy individuals, we cannot rule out that pathological high platelet numbers may lead to the detection of differences between standard and platelet–free plasma. But it should be considered that the platelet count in extreme pathologically samples is only twice or three times higher than the upper reference range of 450,000 platelets/μl in healthy individuals [31]. Noteworthy, in our study a ten-fold difference in the platelet number between standard and platelet-free plasma samples resulted in no significant difference of the profiled plasma metabolome.
In analytical chemistry serum as well as plasma are recommended as sample material of choice. However, blood processing for the generation of serum or plasma is rather different. Whether plasma or serum is the preferable sample material is still controversial discussed. We performed in paired samples three UHPLC-mass spectrometry-driven metabolomics studies. In study 1 metabolite profiles of serum vs plasma were compared. 46% out of 216 identified metabolites showed significant different levels (paired Wilcoxon signed-rank test, p < 0.05, FDR <0.01) with only three metabolites (methionine, C2:0- and C3:0-carnitine) showing lower levels in serum. In study 2 comparison of three different serum blood collection tubes revealed that coagulation and associated processes distinctly alter metabolite levels depending on the tube-specific clotting process. Most pronounced differences were found for the dipeptide phenylalanine-phenylalanine (highest levels in silicate containing serum blood collection tubes). In study 3 possible adverse effects of platelets, which still remain in standard plasma even after correct processing, were investigated. No differences in a pattern of 216 metabolites were detected in the comparison of standard and platelet-free plasma (PFP). Our results give novel insights in fundamental differences between serum and plasma, thereby providing valuable information for analytical chemists for decision making to either use serum or plasma before starting complex and time-consuming analytical investigations.
Trombocitemia esencial
2022, Gaceta Medica de Mexico

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Occurence, etiology, and clinical significance of extreme thrombocytosis: A study of 280 cases

Abstract

Lancet

Blood

Thrombocythaemia

Clin Haematol

Thrombocytosis and thrombocythemia

Hematol Oncol Clin North Am

The incidence of thrombotic and hemorrhagic disorders in association with extreme thrombocytosis: an analysis of 129 cases

Am J Hematol

Thrombocytosis

Essential thrombocythemia: an interim report from the Polycythemia Vera Study Group

Semin Hematol

Therapeutic recommendations in polycythemia vera based on Polycythemia Vera Study Group protocols

Semin Hematol

Kawasaki syndrome

Case records of the Massachusetts General Hospital

N Engl J Med

Profound thrombocytosis in a patient with iron-lack anemia

South Med J