Secondary Thrombocytosis Workup
- Author: Koyamangalath Krishnan, MD, FRCP, FACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP more...
The laboratory workup in cases of secondary thrombocytosis (reactive thrombocytosis) includes the following:
Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)
Leukocyte alkaline phosphatase, vitamin B-12
Antinuclear antibody (ANA), rheumatoid factor (RF)
Iron studies (serum iron, total iron-binding capacity [TIBC], serum ferritin)
Peripheral blood smear review
If the clinical presentation does not clearly differentiate between primary (clonal) and secondary thrombocytosis, further tests may be indicated to exclude or confirm a diagnosis of disorders that cause clonal thrombocytosis, as follows:
Cytogenetic studies: The presence of the Philadelphia chromosome (Ph) found in chronic myelogenous leukemia (CML) may also be identified using reverse transcriptase-polymerase chain reaction (RT-PCR) to identify the bcr-abl fusion transcript or by using Southern blot analysis for identification of bcr-abl genomic rearrangements.
Essential thrombocythemia is a diagnosis of exclusion that is based on the following numeric criteria (adapted from Hoffman R. Primary thrombocythemia. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. Philadelphia, Pa: Churchill Livingstone; 2000:1188-204). Patients who meet criteria 1-5 and more than three of criteria 6-11 are considered to have essential thrombocytosis.
- Platelet count greater than 600,000/mm3 on two occasions, separated by a 1-month interval
- Absence of an identifiable cause of secondary thrombocytosis
- Normal red blood cell mass
- Absence of significant bone marrow fibrosis (ie, less than one third of the bone marrow)
- Absence of the Philadelphia chromosome (Ph) by karyotyping or absence of the bcr-abl fusion product
- Splenomegaly by physical examination or ultrasonography
- Bone marrow hypercellularity with megakaryocyte hyperplasia
- Presence of abnormal bone marrow hematopoietic progenitor cells as determined by the growth of endogenous erythroid cells and/or megakaryocyte colonies with increased sensitivity to interleukin-3 (IL-3)
- Normal levels of CRP and IL-6
- Absence of iron deficiency anemia, as documented by either a normal bone marrow–stainable iron or normal serum ferritin level
- In females, demonstration of clonal hematopoiesis by restriction fragment length polymorphism (RFLP) analysis of genes present on the X chromosome
Perform an ultrasound of the abdomen if the presence of splenomegaly is uncertain.
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