Medscape is available in 5 Language Editions – Choose your Edition here.


Secondary Thrombocytosis Workup

  • Author: Koyamangalath Krishnan, MD, FRCP, FACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
Updated: Apr 14, 2016

Laboratory Studies

The laboratory workup in cases of secondary thrombocytosis (reactive thrombocytosis) includes the following:

  • Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)
  • Cytogenetic analysis
  • 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).[4] Patients who meet criteria 1-5 and more than three of criteria 6-11 are considered to have essential thrombocytosis.

  1. Platelet count greater than 600,000/mm3 on two occasions, separated by a 1-month interval
  2. Absence of an identifiable cause of secondary thrombocytosis
  3. Normal red blood cell mass
  4. Absence of significant bone marrow fibrosis (ie, less than one third of the bone marrow)
  5. Absence of the Philadelphia chromosome (Ph) by karyotyping or absence of the bcr-abl fusion product
  6. Splenomegaly by physical examination or ultrasonography
  7. Bone marrow hypercellularity with megakaryocyte hyperplasia
  8. 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)
  9. Normal levels of CRP and IL-6
  10. Absence of iron deficiency anemia, as documented by either a normal bone marrow–stainable iron or normal serum ferritin level
  11. In females, demonstration of clonal hematopoiesis by restriction fragment length polymorphism (RFLP) analysis of genes present on the X chromosome

Imaging Studies

Perform an ultrasound of the abdomen if the presence of splenomegaly is uncertain.

Contributor Information and Disclosures

Koyamangalath Krishnan, MD, FRCP, FACP Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, Royal College of Physicians

Disclosure: Nothing to disclose.


Devapiran Jaishankar, MBBS Associate Professor, Division of Oncology, East Tennessee State University, James H Quillen College of Medicine

Devapiran Jaishankar, MBBS is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hematology, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Marcel E Conrad, MD Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, SWOG

Disclosure: Partner received none from No financial interests for none.

Chief Editor

Srikanth Nagalla, MBBS, MS, FACP Director, Clinical Hematology, Cardeza Foundation for Hematologic Research; Assistant Professor of Medicine, Division of Hematology, Associate Program Director, Hematology/Medical Oncology Fellowship, Assistant Program Director, Internal Medicine Residency, Jefferson Medical College of Thomas Jefferson University

Srikanth Nagalla, MBBS, MS, FACP is a member of the following medical societies: American Society of Hematology, Association of Specialty Professors

Disclosure: Nothing to disclose.


Wadie F Bahou, MD Chief, Division of Hematology, Hematology/Oncology Fellowship Director, Professor, Department of Internal Medicine, State University of New York at Stony Brook

Wadie F Bahou, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

  1. Vora AJ, Lilleyman JS. Secondary thrombocytosis. Arch Dis Child. 1993 Jan. 68(1):88-90. [Medline]. [Full Text].

  2. Mantadakis E, Tsalkidis A, Chatzimichael A. Thrombocytosis in childhood. Indian Pediatr. 2008 Aug. 45(8):669-77. [Medline].

  3. Mata Fernández C, Pérez-Miranda Castillo J, Galarón García P, Cela de Julián E, Beléndez Bieler C. [Thrombocytosis in the oncology-haematology clinic: description, aetiological diagnosis and progression thrombocytosis] [Spanish]. An Pediatr (Barc). 2008 Jul. 69(1):10-4. [Medline]. [Full Text].

  4. Hoffman R. Primary thrombocythemia. Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. Philadelphia, Pa: Churchill Livingstone; 2000. 1188-204.

  5. Hellmann A. Myeloproliferative syndromes: diagnosis and therapeutic options. Pol Arch Med Wewn. 2008 Dec. 118(12):756-60. [Medline].

  6. Tefferi A, Ho TC, Ahmann GJ, Katzmann JA, Greipp PR. Plasma interleukin-6 and C-reactive protein levels in reactive versus clonal thrombocytosis. Am J Med. 1994 Oct. 97(4):374-8. [Medline].

  7. Kutti J, Wadenvik H. Diagnostic and differential criteria of essential thrombocythemia and reactive thrombocytosis. Leuk Lymphoma. 1996 Sep. 22 suppl 1:41-5. [Medline].

  8. Araneda M, Krishnan V, Hall K, et al. Reactive and clonal thrombocytosis: proinflammatory and hematopoietic cytokines and acute phase proteins. South Med J. 2001 Apr. 94(4):417-20. [Medline].

  9. Haidopoulou K, Goutaki M, Lemonaki M, Kavga M, Papa A. Reactive thrombocytosis in children with viral respiratory tract infections. Minerva Pediatr. 2011 Aug. 63(4):257-62. [Medline].

  10. Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Postsplenectomy reactive thrombocytosis. Proc (Bayl Univ Med Cent). 2009 Jan. 22(1):9-12. [Medline]. [Full Text].

  11. Indolfi G, Catania P, Bartolini E, et al. Incidence and clinical significance of reactive thrombocytosis in children aged 1 to 24 months, hospitalized for community-acquired infections. Platelets. 2008 Sep. 19(6):409-14. [Medline].

  12. Buss DH, Cashell AW, O'Connor ML, Richards F 2nd, Case LD. Occurrence, etiology, and clinical significance of extreme thrombocytosis: a study of 280 cases. Am J Med. 1994 Mar. 96(3):247-53. [Medline].

  13. Chiarello P, Magnolia M, Rubino M, Liguori SA, Miniero R. Thrombocytosis in children. Minerva Pediatr. 2011 Dec. 63(6):507-13. [Medline].

  14. Chanet V, Tournilhac O, Dieu-Bellamy V, et al. Isolated spleen agenesis: a rare cause of thrombocytosis mimicking essential thrombocythemia. Haematologica. 2000 Nov. 85(11):1211-3. [Medline]. [Full Text].

  15. Katiyar R, Patne SC, Pankaj P. Post electric shock reactive thrombocytosis. J Clin Diagn Res. 2015 Apr. 9 (4):ED10-1. [Medline]. [Full Text].

  16. Kulnigg-Dabsch S, Schmid W, Howaldt S, Stein J, Mickisch O, Waldhör T, et al. Iron deficiency generates secondary thrombocytosis and platelet activation in IBD: the randomized, controlled thromboVIT trial. Inflamm Bowel Dis. 2013 Jul. 19(8):1609-16. [Medline].

  17. Tsantes AE, Dimoula A, Bonovas S, Mantzios G, Tsirigotis P, Zoi K, et al. The role of the Platelet Function Analyzer (PFA)-100 and platelet aggregometry in the differentiation of essential thrombocythemia from reactive thrombocytosis. Thromb Res. 2009 Aug 5. [Medline].

  18. Alberio L. Do we need antiplatelet therapy in thrombocytosis? Pro. Diagnostic and pathophysiologic considerations for a treatment choice. Hamostaseologie. 2015 Feb 24. 35 (2):[Medline].

  19. Harrison MT, Short P, Williamson PA, Singanayagam A, Chalmers JD, Schembri S. Thrombocytosis is associated with increased short and long term mortality after exacerbation of chronic obstructive pulmonary disease: a role for antiplatelet therapy?. Thorax. 2014 Jul. 69(7):609-15. [Medline].

  20. Cohen JG, Tran AQ, Rimel BJ, Cass I, Walsh CS, Karlan BY, et al. Thrombocytosis at secondary cytoreduction for recurrent ovarian cancer predicts suboptimal resection and poor survival. Gynecol Oncol. 2014 Mar. 132(3):556-9. [Medline].

  21. Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. Br J Haematol. 2005 Apr. 129(2):165-77. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.