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 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[1]
  • Unknown
  • Mutation
+ - - -/+ + Elderly Exposure to +/- Petechiae, purpura, diffuse erythematous rash + Nl + + ↑/↓
  • Large platelets
  • Ovalomacrocytosis
  • Basophilic stippling
  • Howell-Jolly body
  • Pelger-Huet anomaly
  • Ring sideroblasts
Nl Nl Nl NA Bone marrow examination + clinical manifestation
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 +
  • 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

References

  1. Natelson, Ethan A.; Pyatt, David (2013). "Acquired Myelodysplasia or Myelodysplastic Syndrome: Clearing the Fog". Advances in Hematology. 2013: 1–11. doi:10.1155/2013/309637. ISSN 1687-9104.