Thrombocytosis: Increase in Circulating Platelets

Almira Coleen · 28問 · 2年前

通報

問題一覧

Increase in circulating platelets

Thrombocytosis

Abnormally high platelet count (>450,000/mL)

Thrombocytosis

Reactive vs. Myeloproliferative Disorders

Thrombocytosis

Thresholds: Reactive

≤800,000/mL

Thresholds: Myeloproliferative

often exceeds 1,000,000/mL

Excessive Production

Absolute

Temporary Production

Relative

Leukemia

Absolute

Injury

Relative

PV - Polycythemia Vera

Primary

Reactive, Acute blood less

Secondary

Also known as secondary thrombocytosis

Reactive Thrombocytosis

Refers to an elevated platelet count that occurs as a response to an underlying condition rather than a primary disorder of platelet production.

Reactive Thrombocytosis

Junica has acute blood loss, splenectomy, childbirth, chronic inflammatory diseases, infections, iron deficiency anemia, malignancy

Reactive thrombocytosis

Platelet production responsive to regulatory stimuli (e.g., thrombopoietin)

Reactive Thrombocytosis

Thrombopoietin

Reactive Thrombocytosis

Morphologically normal platelets produced

Reactive Thrombocytosis

Bone marrow findings: normal to increased megakaryocytes that are normal in morphology

Reactive Thrombocytosis

Clinical Implications • No association with thrombosis, hemorrhage or abnormal TPO levels • Symptoms usually absent • Disappears with resolution of underlying disorder

Reactive Thrombopoiesis

Thrombocytosis After Hemorrhage or Surgery: Direct loss of platelets and consumption, increased coagulation activity consumes platelets to form clots to stop bleeding.

Initial thrombocytopenia (2-6 days)

The body’s hematopoietic system, especially the bone marrow, is stimulated to increase platelet production

Rebound thrombocytosis

Post-acute hemorrhage: Initial thrombocytopenia

2-6 days

Post-acute hemorrhage: Rebound thrombocytosis

Returns to normal in 10-16 days

Involves tissue trauma and sometimes controlled blood loss, triggering both an initial thrombocytopenia and a subsequent increase in platelet production to aid in wound healing and to restore platelet levels.

Similar patterns observed post-surgery

Typical rise in platelet count >1,000,000/mL

Postsplenectomy Thrombocytosis

Initial increase of 30% to 50%

Postsplenectomy Thrombocytosis

Elevated levels persist for 1-3 months or longer in some cases

Postsplenectomy Thrombocytosis

Seen in 50% of mild iron deficiency anemia cases

Thrombocytosis and Iron Deficiency Anemia

Severe iron deficiency: thrombocytosis or thrombocytopenia

Thrombocytosis and Iron Deficiency Anemia

Severe iron deficiency: Thrombocytosis or Thrombocytopenia - iron deficiency may stimulate the production of both RBCs and platelets in the bone marrow

Thrombocytosis and Iron Deficiency Anemia

Thrombocytosis and Iron Deficiency Anemia Theraphy: Normalization of platelet count typically follows _______.

Iron therapy

Thrombocytosis: Indicator of inflammation

CRP, Fibrinogen

Thrombocytosis Associated with Inflammation Conditions:

Rheumatoid arthritis, Rheumatic fever, Ulcerative colitis, Infections and malignancies

Acute vasculitic syndrome in children

Kawasaki Disease

Elevated platelet counts (up to 2,000,000/mL)

Kawasaki Disease

Junica has prolonged fever, potential cardiovascular complications

Kawasaki Disease

Diagnosis through exclusion; treated with antiplatelet agents

Kawasaki Disease

Other Causes of Thrombocytosis:

Tumors, Hemophilic patients may have elevated counts without bleeding, Exercise-Induced Thrombocytosis

Other Causes of Thrombocytosis: Tumors

Hodgkin disease

- Temporary increase due to splenic release or hemoconcentration - Returns to baseline within 30 minutes

Exercise-Induced Thrombocytosis

Autonomous increase in platelet count due to myeloproliferative disorders

Primary Thrombocytosis

Four chronic myeloproliferative disorders:

Polycythemia Vera, Chronic Myelogenous Leukemia (CML), Primary Myelofibrosis, Essential Thrombocythemia (ET)

A clonal disorder linked to chronic myeloproliferative diseases.

Essential Thrombocythemia (ET)

Characteristics: Platelet count > 1 million/mL Uncontrolled megakaryocyte proliferation

Essential Thrombocythemia (ET)

Diagnosis Criteria: Persistent marked elevation of platelet count. Rule out other myeloproliferative disorders and systemic conditions

Essential Thrombocythemia (ET)

Junica has Hemorrhage, Platelet dysfunction, Thrombosis (10%-20% incidence at diagnosis)

Essential Thrombocythemia (ET)

Junica has Digital pain, Digital Gangrene and Erythromelalgia:

Thrombosis in Microvasculature

Throbbing pain and burning sensation in extremities

Erythromelalgia

Throbbing pain and burning sensation in extremities

Erythromelalgia

Junica has coronary, renal, and peripheral arteries with venous thrombosis in pelvic and hepatic veins.

Thrombosis in Microvasculature

Primary cause of mortality in ET patients.

Thrombotic Complications

Hemorrhagic Complications: Bleeding Symptoms

Mucocutaneous bleeding, Gastrointestinal bleeding

Nose, mouth, urinary tract

Mucocutaneous bleeding

Combination of thrombotic and hemorrhagic episodes.

Hemorrhagic Complications

A patient with essential thrombocythemia who has had a thrombotic event may have a hemorrhagic event later

Paradoxical Events of Hemorrhagic Complications

Peripheral blood findings: Agranular or hypogranular and have a clear, light blue appearance and presence of giant or bizarrely shaped platelets

Platelet

Peripheral Blood Findings: Increased platelet size and clumping and megakaryocyte fragments or nuclei

Platelet

Bone Marrow Findings: Increased number and size of megakaryocytes.

Platelet

Treatment Considerations: Risks of lowering platelet counts vs. thrombosis/hemorrhage.

Management of Essential Thrombocythemia

Treatment Considerations, Prophylactic Treatments, Current Therapies, Controversies in Treatment

Prophylactic Treatments: - Myelosuppressive agents (e.g., hydroxyurea, anagrelide). - Platelet apheresis in severe cases.

Essential Thrombocythemia

Prophylactic Treatments:

Myelosuppressive agents, Platelet apheresis in severe cases.

Management of Essential Thrombocythemia: Current Therapies requires 60% complete remission but tolerance issues.

Interferon-α

Management of Essential Thrombocythemia: Controversies in Treatment which debate over treatment necessity.

Asymptomatic Patients

Management of Essential Thrombocythemia: Controversies in Treatment which preventative therapy reduces morbidity but does not

Long-term Outcomes

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