Thrombocytosis - Revision history

ClaireLewis: /* Differential DiagnosisTefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017. */

2019-09-30T23:46:20Z

Differential DiagnosisTefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.

← Older revision		Revision as of 23:46, 30 September 2019
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	==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==		==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==
	===Reactive thrombocytosis===		===Reactive thrombocytosis===
	* Acute blood loss		* Acute [[hemorrhage\|blood loss]]
	* Acute hemolytic anemia		* Acute [[hemolytic anemia]]
	* Iron deficiency anemia		* Iron deficiency [[anemia]]
	* Treatment of [[vitamin B12 deficiency]]		* Treatment of [[vitamin B12 deficiency]]
	*Rebound effect after thrombocytopenia treatment		* Rebound effect after [[thrombocytopenia]] treatment
	* Metastatic cancer		* Metastatic cancer
	* [[Lymphoma]]		* [[Lymphoma]]
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	* Thermal [[burn]]		* Thermal [[burn]]
	* [[MI]]		* [[MI]]
	* Severe trauma		* Severe [[trauma]]
	* [[Acute pancreatitis]]		* [[Acute pancreatitis]]
	* Post-surgery, especially [[splenectomy]]		* Post-surgery, especially [[splenectomy]]
	* CABG		* CABG
	* [[TB]]		* [[TB]]
	* Acute bacterial/viral infections		* Acute [[bacterial disease\|bacterial]]/[[viruses\|viral]] infections
	* Asplenia		* [[asplenic patient\|Asplenia]]
	* [[Allergic reaction]]		* [[Allergic reaction]]
	* Medication reactions: vincristine, epinephrine, glucocorticoids, IL-1B, ATRA, thrombopoietin, LMWH (uptodate)		* Medication reactions: vincristine, [[epinephrine]], [[glucocorticoids]], IL-1B, ATRA, thrombopoietin, [[LMWH]]<ref>uptodate</ref>

	===Autonomous thrombocytosis===		===Autonomous thrombocytosis===
	* Essential ~~thrombocytopenia~~		* [[Essential thrombocytosis]]
	* [[Polycythemia vera]]		* [[Polycythemia vera]]
	* Mixed myelodysplastic and/or myeloproliferative syndrome		* Mixed [[myelodysplastic syndrome\|myelodysplastic]] and/or [[myeloproliferative disorders\|myeloproliferative syndrome]]

	===Spurious (false) thrombocytosis===		===Spurious (false) thrombocytosis===

ClaireLewis at 14:48, 1 September 2019

2019-09-01T14:48:48Z

← Older revision		Revision as of 14:48, 1 September 2019
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	===Autonomous thrombocytosis (AT)<ref>Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.</ref>===		===Autonomous thrombocytosis (AT)<ref>Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.</ref>===
	*Accounts for 15% of cases		*Accounts for 15% of cases
	*A primary problem that results from [[myeloproliferative disorders]] or [[myelodysplastic ~~disorders~~]], such as essential [[thrombocytopenia]] or [[polycythemia vera]].		*A primary problem that results from [[myeloproliferative disorders]] or [[myelodysplastic syndrome]]s, such as essential [[thrombocytopenia]] or [[polycythemia vera]].
	*Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis.		*Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis.
	*There are no diagnostic studies to differentiate RT versus AT.		*There are no diagnostic studies to differentiate RT versus AT.
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	* Severe trauma		* Severe trauma
	* [[Acute pancreatitis]]		* [[Acute pancreatitis]]
	* Post-surgery, especially splenectomy		* Post-surgery, especially [[splenectomy]]
	* CABG		* CABG
	* [[TB]]		* [[TB]]

ClaireLewis: /* Autonomous thrombocytosis */

2019-05-27T22:03:57Z

Autonomous thrombocytosis

← Older revision		Revision as of 22:03, 27 May 2019
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	====Asymptomatic====		====Asymptomatic====
	*81mg [[ASA]] PO daily.		*81mg [[ASA]] PO daily.
	*If high risk for thrombotic event (>60 yrs, history of thrombosis, or known JAK2 mutation), consider 15mg/kg hydroxyurea PO daily. Consult if available.		*If high risk for thrombotic event (>60 yrs, history of thrombosis, or known JAK2 mutation), consider 15mg/kg [[hydroxyurea]] PO daily. Consult if available.
	*Second line agents include ~~IFN~~-~~alpha~~, anagrelide, and pipobroman.		*Second line agents include [[interferon-α]], anagrelide, and pipobroman.

	====Thrombosis due to AT====		====Thrombosis due to AT====
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	*81mg [[ASA]] PO daily.		*81mg [[ASA]] PO daily.
	*Consult heme/onc		*Consult heme/onc
	*Consider 3-5 million U ~~IFN alpha~~ SQ daily if <40 years old. 15mg/kg hydroxyurea PO daily if >40 years old. Goal platelet count <400,000/microL.		*Consider 3-5 million U [[interferon-α]] SQ daily if <40 years old. 15mg/kg [[hydroxyurea]] PO daily if >40 years old. Goal platelet count <400,000/microL.
	*Platelet apheresis if platelet count >800,000/microL.		*Platelet apheresis if platelet count >800,000/microL.

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	*Discontinue antiplatelet medications.		*Discontinue antiplatelet medications.
	*Consult.		*Consult.
	*Consider 3-5 million U ~~IFN alpha~~ SQ daily if <40 years old. 15mg/kg hydroxyurea PO daily if >40 years old. Goal platelet count <400,000/microL.<ref>Bleeker, "Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies," Thrombosis. 2011; 2011: 536062. Published online 2011 Jun 8. doi:10.1155/2011/536062.</ref>		*Consider 3-5 million U [[interferon-α]] SQ daily if <40 years old. 15mg/kg [[hydroxyurea]] PO daily if >40 years old. Goal platelet count <400,000/microL.<ref>Bleeker, "Thrombocytosis: Diagnostic Evaluation, Thrombotic Risk Stratification, and Risk-Based Management Strategies," Thrombosis. 2011; 2011: 536062. Published online 2011 Jun 8. doi:10.1155/2011/536062.</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Clinical FeaturesTefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017. */

2019-02-01T02:28:31Z

Clinical FeaturesTefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.

← Older revision		Revision as of 02:28, 1 February 2019
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	*Thrombosis (leading cause of morbidity and mortality)		*Thrombosis (leading cause of morbidity and mortality)
	**Arteries (more common)		**Arteries (more common)
	***Stroke, TIA, MI, unstable angina		***[[Stroke]], [[TIA]], [[MI]], [[unstable angina]]
	**Venous system		**Venous system
	***[[DVT]], [[PE]], [[Budd-Chiari syndrome]]		***[[DVT]], [[PE]], [[Budd-Chiari syndrome]]
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	**Generally in the nasal and bucchal mucosa and the GI tract		**Generally in the nasal and bucchal mucosa and the GI tract
	*Vasomotor symptoms (due to microvascular disturbances)		*Vasomotor symptoms (due to microvascular disturbances)
	**Headache, lightheadedness, syncope, acral paresthesia, atypical chest pain, livedo reticularis, erythromelalgia, and transient visual disturbances		**[[Headache]], lightheadedness, [[syncope]], acral [[paresthesia]], atypical [[chest pain]], livedo reticularis, erythromelalgia, and transient [[visual disturbances]]

	==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==		==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==

Rossdonaldson1: /* Clinical FeaturesTefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017. */

2019-02-01T02:27:45Z

Clinical FeaturesTefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.

← Older revision		Revision as of 02:27, 1 February 2019
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	==Clinical Features<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==		==Clinical Features<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==
	''Generally asymptomatic and found on routine lab testing''		''Generally asymptomatic and found on routine lab testing; complications are typically from AT disorders''
	*Complications (generally seen in AT disorders)
	*Thrombosis (leading cause of morbidity and mortality)		*Thrombosis (leading cause of morbidity and mortality)
	**Arteries (more common)		**Arteries (more common)

Rossdonaldson1: /* Reactive thrombocytosis */

2019-02-01T02:27:04Z

Reactive thrombocytosis

← Older revision		Revision as of 02:27, 1 February 2019
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	* POEMS syndrome		* POEMS syndrome
	* Thermal [[burn]]		* Thermal [[burn]]
	* [[MI ]]		* [[MI]]
	* Severe trauma		* Severe trauma
	* [[Acute pancreatitis]]		* [[Acute pancreatitis]]

Rossdonaldson1: /* Clinical Features */

2019-02-01T02:26:39Z

Clinical Features

← Older revision		Revision as of 02:26, 1 February 2019
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	*There are no diagnostic studies to differentiate RT versus AT.		*There are no diagnostic studies to differentiate RT versus AT.

	==Clinical Features==		==Clinical Features<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==
	*Generally asymptomatic and found on routine lab testing.		''Generally asymptomatic and found on routine lab testing''
	*Complications ~~are~~ seen in AT disorders ~~and include thrombosis, bleeding, or vasomotor symptoms. Thrombotic complications are the~~ leading cause of morbidity and mortality~~. Thrombosis commonly occurs in arteries~~ (~~stroke~~, TIA, MI, unstable angina~~), but can also occur in the venous~~ system ([[DVT]], [[PE]], [[Budd-Chiari syndrome]]). Serious bleeding ~~is a~~ less common ~~complication and is generally seen~~ in the nasal and bucchal mucosa and the GI tract.		*Complications (generally seen in AT disorders)
	*Vasomotor symptoms ~~are~~ due to microvascular disturbances ~~and include: headache~~, lightheadedness, syncope, acral paresthesia, atypical chest pain, livedo reticularis, erythromelalgia, and transient visual disturbances~~. <ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>~~		*Thrombosis (leading cause of morbidity and mortality)
			**Arteries (more common)
			***Stroke, TIA, MI, unstable angina
			**Venous system
			***[[DVT]], [[PE]], [[Budd-Chiari syndrome]]
			*Serious bleeding (less common)
			**Generally in the nasal and bucchal mucosa and the GI tract
			*Vasomotor symptoms (due to microvascular disturbances)
			**Headache, lightheadedness, syncope, acral paresthesia, atypical chest pain, livedo reticularis, erythromelalgia, and transient visual disturbances

	==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==		==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==

Rossdonaldson1: /* Background */

2017-09-19T12:10:34Z

Background

← Older revision		Revision as of 12:10, 19 September 2017
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	==Background==		==Background==
	*Defined as a platelet count >450,000/microL.		*Defined as a platelet count >450,000/microL.
	*Can be reactive or autonomous.
	**Reactive thrombocytosis (RT) ~~is the most~~ common cause of thrombocytosis, accounting for 85% of cases. ~~RT is a~~ reaction to another process, such as inflammation, infection, cancer, or iron deficiency. ~~RT rarely~~ causes complications even with extremely elevated platelet counts (>1,000,000/microL).		===Reactive thrombocytosis (RT)===
	**Autonomous thrombocytosis (AT) ~~accounts~~ for 15% of cases~~. AT is a~~ primary problem that results from [[myeloproliferative disorders]] or [[myelodysplastic disorders]], such as essential [[thrombocytopenia]] or [[polycythemia vera]]. Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis. There are no diagnostic studies to differentiate RT versus AT. ~~<ref>Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.</ref>~~		*Most common cause of thrombocytosis, accounting for 85% of cases.
			*A reaction to another process, such as inflammation, infection, cancer, or iron deficiency.
			*Rarely causes complications even with extremely elevated platelet counts (>1,000,000/microL).

			===Autonomous thrombocytosis (AT)<ref>Schafer, "Thrombocytosis," N Engl J Med 2004;350:1211-9.</ref>===
			*Accounts for 15% of cases
			*A primary problem that results from [[myeloproliferative disorders]] or [[myelodysplastic disorders]], such as essential [[thrombocytopenia]] or [[polycythemia vera]].
			*Complications, such as bleeding and/or thrombosis, are more likely with AT than with RT so it is clinically important to differentiate reactive thrombocytosis versus autonomous thrombocytosis.
			*There are no diagnostic studies to differentiate RT versus AT.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis */

2017-09-19T12:09:06Z

Differential Diagnosis

← Older revision		Revision as of 12:09, 19 September 2017
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	*Vasomotor symptoms are due to microvascular disturbances and include: headache, lightheadedness, syncope, acral paresthesia, atypical chest pain, livedo reticularis, erythromelalgia, and transient visual disturbances. <ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>		*Vasomotor symptoms are due to microvascular disturbances and include: headache, lightheadedness, syncope, acral paresthesia, atypical chest pain, livedo reticularis, erythromelalgia, and transient visual disturbances. <ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>

	==Differential Diagnosis==		==Differential Diagnosis<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>==
	*Reactive thrombocytosis:		===Reactive thrombocytosis===
	** Acute blood loss		* Acute blood loss
	** Acute hemolytic anemia		* Acute hemolytic anemia
	** Iron deficiency anemia		* Iron deficiency anemia
	** Treatment of vitamin B12 deficiency		* Treatment of [[vitamin B12 deficiency]]
	**Rebound effect after thrombocytopenia treatment		*Rebound effect after thrombocytopenia treatment
	** Metastatic cancer		* Metastatic cancer
	** Lymphoma		* [[Lymphoma]]
	** Rheumatologic disorders		* Rheumatologic disorders
	** IBD		* [[IBD]]
	** Celiac disease		* Celiac disease
	** Kawasaki disease		* [[Kawasaki disease]]
	** Nephrotic syndrome		* [[Nephrotic syndrome]]
	** POEMS syndrome		* POEMS syndrome
	** Thermal burn		* Thermal [[burn]]
	** MI		* [[MI ]]
	** Severe trauma		* Severe trauma
	** Acute pancreatitis		* [[Acute pancreatitis]]
	** Post-surgery, especially splenectomy		* Post-surgery, especially splenectomy
	** CABG		* CABG
	** TB		* [[TB]]
	** Acute bacterial/viral infections		* Acute bacterial/viral infections
	** Asplenia		* Asplenia
	** Allergic ~~reactions~~		* [[Allergic reaction]]
	** Medication reactions: vincristine, epinephrine, glucocorticoids, IL-1B, ATRA, thrombopoietin, LMWH (uptodate)		* Medication reactions: vincristine, epinephrine, glucocorticoids, IL-1B, ATRA, thrombopoietin, LMWH (uptodate)
	*Autonomous thrombocytosis:
	** Essential ~~Thrombocytopenia~~		===Autonomous thrombocytosis===
	** Polycythemia ~~Vera~~		* Essential thrombocytopenia
	** Mixed myelodysplastic and/or myeloproliferative syndrome		* [[Polycythemia vera]]
	*Spurious (false) thrombocytosis:		* Mixed myelodysplastic and/or myeloproliferative syndrome
	** Mixed cryoglobulinemia
	** Cytoplasmic fragments		===Spurious (false) thrombocytosis===
	** Bacteremia~~<ref>Tefferi, "Diagnosis and Clinical Manifestations of Essential Thrombocythemia," UpToDate, Jul. 2017.</ref>~~		* Mixed cryoglobulinemia
			* Cytoplasmic fragments
			* [[Bacteremia]]

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Disposition */

2017-09-19T11:55:55Z

Disposition

← Older revision		Revision as of 11:55, 19 September 2017
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	*Disposition is based on underlying disorder.		*Disposition is based on underlying disorder.

			===Autonomous thrombocytosis===
	*If asymptomatic AT, consider outpatient treatment with close follow up.		*If asymptomatic, consider outpatient treatment with close follow up.
	*AT thrombosis or bleeding complications should be admitted for stabilization and further work up.		*If thrombosis or bleeding complications, should be admitted for stabilization and further work up.

	==External Links==		==External Links==