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]

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	Rash	Bleeding	BP	Splenomegaly	Jaundice	Other	CBC			PBS	Bone marrow exam	PT	PTT	UA
				Increased megakaryocyte proliferation	Accelerated platelet release	Reduced platelet turnover												Plt	HB	WBC
Autonomous thrombocytosis	Hematologic malignancies	Essential thrombocythemia	Acquired mutation of JAK2, CALR, or MPL	+	-	-	-	+				Flushing					Erythromelalgia	↑										Thrombo-hemorrhagic complications
		Polycythemia vera	Acquired mutation of JAK2	+	-	-	-	+	Mean age >60 years old		-	Facial plethora	-	Nl	+	-	Erythromelalgia Pruritus	↑	↑↑									Thrombo-hemorrhagic complications
		Primary myelofibrosis	Bone marrow fibrosis Mutation in JAK2, CALR, or MPL	+	-	-	-	+										↑										Thrombo-hemorrhagic complications
		Chronic myeloid leukemia	Translocation (9;22), the Philadelphia chromosome BCR-ABL1 oncogene	+	-	-	-	+							+	-		↑	↑		Immature leukocytes Leukemic blasts Leukoerythroblastic features Giant platelets							Increase of immature myeloid cells
		Acute myeloid leukemia		+	-	-	-	+										↑			Leukemic blasts Leukoerythroblastic features Giant platelets
		Myelodysplastic syndromes	Unknown Mutation	+	-	-	-/+	+	Elderly	Exposure to Chemotherapy Radiation therapy Tobacco smoke	+/-	Petechiae, purpura, diffuse erythematous rash	+	Nl	+	+	Shortness of breath Fatigue	↑/↓	↓	↓	Large platelets Ovalomacrocytosis Basophilic stippling Howell-Jolly body Pelger-Huet anomaly Ring sideroblasts	Impaired myeloid maturation Dyserythropoiesis Dysgranulopoiesis Dysmegakaryocytopoiesis Hypercellular bone marrow Fibrosis	Nl	Nl	Nl	NA	Bone marrow examination + clinical manifestation	Thrombosis at unusual sites Thrombosis in younger patients Might transformed to acute leukemia
	Familial thrombocytosis		Mutation in TPO and MPL	+	-	-	+	-										↑	Nl	Nl	Giant platelets Platelet conglomerates Bizarre forms Megakaryocytic fragments Platelet hypogranularity							Mendelian inheritance High penetrance Polyclonal hematopoiesis
Category	Condition		Etiology	Increased megakaryocyte proliferation	Accelerated platelet release	Reduced platelet turnover	Inherited	Acquried	Demography	History	Fever	Rash	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings
Reactive thrombocytosis	Anemia/ blood loss	Iron deficiency Blood loss Hemolysis		+						History of bleeding or iron deficiency								↑	↓									Required iron studies
	Infection	Chronic infections		+	+													↑		↑
		Tuberculosis		+	+													↑		↑
		Acute bacterial and viral infections		+	+													↑		↑
	Inflammation	Vasculitides		+	+													↑		↑
		Acute pancreatitis		+	+													↑		↑
		Malignancy		+	+													↑		↑
	Condition		Etiology	Increased megakaryocyte proliferation	Accelerated platelet release	Reduced platelet turnover	Inherited	Acquried	Demography	History	Fever	Rash	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings
	Tissue damage	Thermal burns																↑
		Trauma																↑
		Myocardial infarction																↑
	Medication	Myelosuppressive agents																↑
		Vincristine																↑
		Epinephrine, glucocorticoids																↑
		Interleukin-1B																↑
		All-trans retinoic acid																↑
		Thrombopoietin																↑
	Other	Post-splenectomy or functional asplenia				+				Prior surgical removal of the spleen Sickle cell disease								↑			Howell-Jolly bodies Nucleated RBCs
		Allergic reactions																↑
		Exercise																↑
	Pseudothrombocytosis	Mixed cryoglobulinemia
		Cytoplasmic fragments
Category	Condition		Etiology	Increased megakaryocyte proliferation	Accelerated platelet release	Reduced platelet turnover	Inherited	Acquried	Demography	History	Fever	Rash	Bleeding	BP	Splenomegaly	Jaundice	Other signs	Plt	HB	WBC	PBS	Bone marrow exam	PT	PTT	UA	Imaging	Gold standard	Associated findings