Thrombocytosis - Clinical History
- infections ; malignancies ; collagen vascular diseases ; iron deficiency ; post splenectomy
- myeloproliferative diseases: essential thrombocythemia, agnogenic myeloid metaplasia, polycythemia vera, chronic myelogenous leukemia
- myelodysplasia (rare)
- Most investigators believe that secondary
thrombocytosis is rarely symptomatic in comparison to primary
- thrombocytosis is usually not as severe with secondary thrombocytosis, although occasionally platelet counts of several million have been reported in association with neoplasm.
- Patients should be questioned carefully for :
- systemic and specific symptoms which might suggest infection or neoplasm, for example, fever, weight loss, night sweats, cough, hemoptysis, melena or hematuria
- symptoms of bleeding and / or ischemia (for example transient cerebral ischemic symptoms, chest pain or burning / paresthesias of the fingers or toes suggestive of digital ischemia).
- Treatment of thrombocytosis is controversial. Even in patients with platelet counts > 1,000,000 / ul, treatment is usually withheld until symptoms occur.
- Hydroxyurea treatment appears effective in high-risk
patients with primary (essential) thrombocytosis i.e. patients over 60 years
old, or who have already had a thrombotic event (Cortelazzo et al, 1995).
Recombinant interferon-alpha and anagrelide are other drugs under evaluation (Barbui, 2003)
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