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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
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Imaging Studies

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

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

References
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