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 + - ↑↑
  • Increased cellularity
  • Hyperplasia and clustering of megakaryocytes
  • Bone marrow reticulin may be increased with no collagen fibrosis
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 + -
  • Immature leukocytes
  • Leukemic blasts
  • Leukoerythroblastic features
  • Giant platelets
  • Blast crisis
  • ↑ 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 + + ↑/↓ ↑/↓
  • Leukemic blasts
  • Leukoerythroblastic features
  • Giant platelets
  • "Dry tap" on aspiration
  • Leukemic cells
NA Bone marrow examination + clinical manifestation
Myelodysplastic syndromes[6]
  • 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 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]
  • Mutation in TPO and MPL
+ - - + - Rare familial disease, middle age male and female
  • Family history of thrombocytosis
- 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 isorders
+
  • 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]
Myocardial infarction[14]
Medication Myelosuppressive agents
Vincristine
Epinephrine, glucocorticoids
Interleukin-1B
All-trans retinoic acid
Thrombopoietin
Other Post-splenectomy or functional asplenia +
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 Appearance Bleeding BP Splenomegaly Jaundice Other signs Plt HB WBC PBS Bone marrow exam PT PTT Imaging Gold standard Associated findings

References

  1. Brière, Jean B (2007). Orphanet Journal of Rare Diseases. 2 (1): 3. doi:10.1186/1750-1172-2-3. ISSN 1750-1172. Missing or empty |title= (help)
  2. Arber, D. A.; Orazi, A.; Hasserjian, R.; Thiele, J.; Borowitz, M. J.; Le Beau, M. M.; Bloomfield, C. D.; Cazzola, M.; Vardiman, J. W. (2016). "The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia". Blood. 127 (20): 2391–2405. doi:10.1182/blood-2016-03-643544. ISSN 0006-4971.
  3. Tefferi, Ayalew; Lasho, Terra L.; Jimma, Thitina; Finke, Christy M.; Gangat, Naseema; Vaidya, Rakhee; Begna, Kebede H.; Al-Kali, Aref; Ketterling, Rhett P.; Hanson, Curtis A.; Pardanani, Animesh (2012). "One Thousand Patients With Primary Myelofibrosis: The Mayo Clinic Experience". Mayo Clinic Proceedings. 87 (1): 25–33. doi:10.1016/j.mayocp.2011.11.001. ISSN 0025-6196.
  4. Thompson, Philip A.; Kantarjian, Hagop M.; Cortes, Jorge E. (2015). "Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015". Mayo Clinic Proceedings. 90 (10): 1440–1454. doi:10.1016/j.mayocp.2015.08.010. ISSN 0025-6196.
  5. Rose-Inman, Hayley; Kuehl, Damon (2014). "Acute Leukemia". Emergency Medicine Clinics of North America. 32 (3): 579–596. doi:10.1016/j.emc.2014.04.004. ISSN 0733-8627.
  6. 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.
  7. Ding, J. (2004). "Familial essential thrombocythemia associated with a dominant-positive activating mutation of the c-MPL gene, which encodes for the receptor for thrombopoietin". Blood. 103 (11): 4198–4200. doi:10.1182/blood-2003-10-3471. ISSN 0006-4971.
  8. Wiestner, A.; Padosch, S. A.; Ghilardi, N.; Cesar, J. M.; Odriozola, J.; Shapiro, A.; Skoda, R. C. (2000). "Hereditary thrombocythaemia is a genetically heterogeneous disorder: exclusion of TPO and MPL in two families with hereditary thrombocythaemia". British Journal of Haematology. 110 (1): 104–109. doi:10.1046/j.1365-2141.2000.02169.x. ISSN 0007-1048.
  9. Kuter, David J. (1996). "The Physiology of Platelet Production". Stem Cells. 14 (S1): 88–101. doi:10.1002/stem.5530140711. ISSN 1066-5099.
  10. Hamblin T, Oscier D (September 1978). "Polyarteritis presenting with thrombocytosis and palliated by plasma exchange". Postgrad Med J. 54 (635): 615–7. PMC 2425233. PMID 82963.
  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.
  12. Dinsdale, R. J.; Devi, A.; Hampson, P.; Wearn, C. M.; Bamford, A. L.; Hazeldine, J.; Bishop, J.; Ahmed, S.; Watson, C.; Lord, J. M.; Moiemen, N.; Harrison, P. (2017). "Changes in novel haematological parameters following thermal injury: A prospective observational cohort study". Scientific Reports. 7 (1). doi:10.1038/s41598-017-03222-w. ISSN 2045-2322.
  13. Salim, Ali; Hadjizacharia, Pantelis; DuBose, Joseph; Kobayashi, Leslie; Inaba, Kenji; Chan, Linda S.; Margulies, Daniel R. (2009). "What is the Significance of Thrombocytosis in Patients With Trauma?". The Journal of Trauma: Injury, Infection, and Critical Care. 66 (5): 1349–1354. doi:10.1097/TA.0b013e318191b8af. ISSN 0022-5282.
  14. Nanavati, Amit; Patel, Nainesh; Burke, James (2012). "Thrombocytosis and Coronary Occlusion". JACC: Cardiovascular Interventions. 5 (6): e18–e19. doi:10.1016/j.jcin.2011.12.018. ISSN 1936-8798.