❗ THROMBOCYTOSIS > 450 THOUSAND/µL IS A REASON FOR AN ACTIVE SEARCH FOR THE CAUSE OF THROMBOCYTOSIS! According to the patient: “I gave birth 5 months ago; during pregnancy, I had platelet problems, and I was given an anticoagulant. Now I’m not taking anything. I’m really looking forward to your answer; I see that the tests aren’t great.” Complete blood count (CBC) photo attached. Leukocyte differential is unremarkable. 👉🏻There are 2 main reasons for platelet levels above 450 thousand/µL:
- Chronic iron deficiency anemia. Even with a normal hemoglobin level (latent). This is the most common cause. It often occurs after childbirth. You should ask the patient: was iron deficiency anemia treated? Did she take iron supplements? It is important to do a blood test for ferritin to check for iron deficiency. Sometimes, after treating chronic IDA, platelet levels are the last to return to normal.
- Inflammation. Any chronic inflammation increases platelet levels. Therefore, it is important to know the C-reactive protein level. If these two causes are ruled out – C-reactive protein and ferritin will be normal – then the spleen should be examined (or better yet, ask the patient in advance if it has been removed). And if the spleen is not hypoplastic, then genetic mutations should be tested for: Jak2 V617F, MPL, CALR to look for essential thrombocythemia. ⚠However, I would recommend testing for mutations only if IDA and inflammation have been ruled out, and a second CBC after 4 weeks shows the same platelet elevation – above 450 thousand/µL. 💬One of the online consulting doctors replied that this situation is due to insufficient water intake – there’s no need to worry… 🙅♂There is no need to falsely reassure patients that everything is fine. Of course, some patients don’t want to hear that they need further examination – spending additional time and money on tests… And even in the absence of symptoms, the cause of thrombocytosis must be sought here! Unfortunately, I often notice this lately. Doctors, to earn monetary compensation from patients, say and write flattering words to them. But isn’t the bitter truth much better than a sweet lie?!
