Thrombocytosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Thrombocytosis Differential Diagnosis

Differentiating the diseases that can cause thrombocytosis :

Category Condition Etiology Mechanism Inherited Acquried Clinical manifestations Para−clinical findings Gold standard Associated findings
Demography History Symptoms Signs
Lab Findings Imaging
Fever Appearance Bleeding BP Splenomegaly Jaundice Other CBC PBS Bone marrow exam PT PTT
Increased megakaryocyte proliferation Accelerated platelet release Reduced platelet turnover Plt HB WBC
Autonomous thrombocytosis Hematologic malignancies Essential thrombocythemia[1]
  • Acquired mutation of JAK2, CALR, or MPL
+ - - - + Mean age >60 years old, female > male ±
  • Flushing
+ Nl + - ↑↑ Nl Nl Bone marrow biopsy
  • Thrombo-hemorrhagic complications
Polycythemia vera[2]
  • Acquired mutation of JAK2
+ - - - + Mean age >60 years old -
  • Facial plethora
± Nl + - ↑↑ Bone marrow biopsy
  • Thrombo-hemorrhagic complications
Primary myelofibrosis[3] + - - - + Mean age >60 years old, male> female - + Nl + + ↑/↓ Bone marrow biopsy
  • Thrombo-hemorrhagic complications
  • Variable risk for development of acute leukemia
Chronic myeloid leukemia[4] + - - - + Mean age >50 years old, male> female History of exposure to: + + Nl + -
  • ↑ Proportion of metamyelocytes and other white blood cells at various stages of maturation
Bone marrow biopsy
  • Increase of immature myeloid cells
Acute myeloid leukemia[5]
  • Unknown
+ - - - + Median age of 63 years old + + Nl + + ↑/↓ ↑/↓ NA Bone marrow examination + clinical manifestation
Myelodysplastic syndromes[6] + - - ± + Elderly Exposure to: ± + Nl + + ↑/↓ Nl Nl NA Bone marrow examination + clinical manifestation
Condition Etiology Increased megakaryocyte proliferation Accelerated platelet release Reduced platelet turnover Inherited Acquried Demography History Fever Appearance Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT Imaging Gold standard Associated findings
Familial thrombocytosis[7][8] + - - + - Rare familial disease, middle age male and female -
  • Normal
- Nl - - - Nl Nl Nl Nl NA Genetic study
Reactive thrombocytosis Anemia/

blood loss[9]

+ - - - + Any - + Nl to ↓ - - Depends on the etilogy Nl Nl Nl NA Clinical manifestation
  • Required iron studies
Infection Chronic infections + + - - + Any + ± Nl to ↓ - ± Depends on the etilogy Nl Nl
  • Depends on the etiology
Culture Depends on the etilogy
Tuberculosis + + - - + Any
  • History of close contact
+
  • Cachectic
- Nl - - Nl Nl Nl
  • Cavitation on chest imaging
Clinical manifestation+ culture
Acute bacterial and viral infections + + - - + Any
  • History of close contact
+
  • Acutely ill
- Nl - - Depends on the etilogy Nl Nl
  • Depends on the etiology
Clinical manifestation+ culture
  • Depends on the etiology
Inflammation Vasculitides[10]
  • Unknown
+ + - ± + Any
  • Family history of rheumatologic disorders
+
  • Acutely ill
+ Nl - - Nl to ↓ Nl to ↑ Nl to ↑
  • Depends on the type
Clinical manifestation+ culture
  • Depends on the type
Acute pancreatitis + + - - + Any +
  • Acutely ill
- Nl to ↓ - + Nl to ↓ Nl to ↑ Nl to ↑ Clinical manifestation
Malignancy[11] + + - ± ± Any
  • Prior malignancy
  • Exposure to chemicals
  • Family history of malignancy
+
  • Cachectic
- Nl to ↓ Depends on the type -
  • Tenderness
Nl to ↓ Nl to ↑ Nl to ↑
  • Depends on the type
Biopsy
Condition Etiology Increased megakaryocyte proliferation Accelerated platelet release Reduced platelet turnover Inherited Acquried Demography History Fever Appearance Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT Imaging Gold standard Associated findings
Tissue damage Thermal burns[12] - + - - + Any
  • Thermal burn
+
  • Acutely ill
± Nl to ↓ - ± Nl to ↓ Nl to ↑ Nl to ↑
  • Depend on the involvement
Clinical manifestation
Trauma[13] - + - - + Any ±
  • Acutely ill
± Nl to ↓ - - Nl to ↓ Nl Nl
  • Depend on the involvement
  • Fracture on X-rays
Clinical manifestation
  • Sepsis
  • Associated with higher rates of complications
Myocardial infarction[14] - + - - + Elderly ±
  • Acutely ill
  • Diaphoretic
- Nl to ↓ - - Nl to ↓ Nl Nl Clinical manifestation + enzymes elevation
Medication[15] Vincristine[16] - + - - + Any -
  • Cachectic
- Nl + - Nl to ↓ Nl to ↑ Nl to ↑
  • Depends on the etiology
Clinical manifestation + history of drug consumption
Epinephrine[17]
  • Unknown
  • Activation of chloride transport
+ + - - + Any -
  • Acutely ill
  • Diaphoretic
- Nl to ↓ - - Nl Nl
  • Depends on the etiology
Clinical manifestation + history of drug consumption
Glucocorticoids[18]
  • Stimulate megakaryocytopoiesis
+ + - - + Any + Nl to ↓ - - Nl to ↓ Nl to ↑ Nl to ↑
  • Depends on the etiology
Clinical manifestation + history of drug consumption
Antibiotics[19] + + - - + Any + Nl ± Nl - -
  • Depends on the etiology
Nl Nl Nl
  • Depends on the etiology
Clinical manifestation + history of drug consumption
Thrombopoietin[20][21]
  • Stimulate megakaryocytopoiesis
  • Thrombopoiesis
+ - - - + Any +
  • Chronically ill
- Nl to ↑ - -
  • Depends on the etiology
Nl Nl
  • Depends on the etiology
Clinical manifestation + history of drug consumption
Condition Etiology Increased megakaryocyte proliferation Accelerated platelet release Reduced platelet turnover Inherited Acquried Demography History Fever Appearance Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT Imaging Gold standard Associated findings
Other Post-splenectomy or functional asplenia[22] - - + - + Any ±
  • Normal
+ Nl Asplenia - - Nl Nl Clinical manifestation
Allergic reactions[23]
  • Unknown
  • Activation of chloride transport
+ + - - + Any -
  • Acutely ill
  • Diaphoretic
- Nl to ↓ - - Nl Nl
  • Depends on the etiology
Clinical manifestation
  • Poor prognosis
Exercise[24] + + - - + Athlete
  • Exercise
- Normal - Nl - - NA Nl Nl
  • Depends on the etiology
Clinical manifestation NA
Pseudothrombocytosis Mixed cryoglobulinemia[25]
  • Falsely elevated
- - - - - Any -
  • Atypical cutaneous ulcers
  • Palpable purpura
- Nl - - Nl to ↓
  • Cytoplasmic fragments
Nl Nl Nl NA Skin biopsy
Cytoplasmic fragments[26]
  • Falsely elevated
- - - - - Any NA - Normal - Nl - - NA Nl Nl
  • Cytoplasmic fragments
Nl Nl Nl Nl Repeat NA

References

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  11. Yang, Chen; Jiang, Hui; Huang, Shaozhuo; Hong, Hui; Huang, Xiaowen; Wang, Xiaojie; Liao, Weixin; Wang, Xueyi; Chen, Xuewen; Jiang, Liming (2018). "The prognostic role of pretreatment thrombocytosis in gastric cancer". Medicine. 97 (31): e11763. doi:10.1097/MD.0000000000011763. ISSN 0025-7974.
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