A 45 years old female with known case of HTN, T2DM, Hypothyroidism, having increased platelets (6 lakhs), since last one year. What is the differential diagnosis and management ?



ESSENTIAL THROMBOCYTHEMIA.. The following revised diagnostic criteria for essential thrombocythaemia were proposed in 2005. The diagnosis requires the presence of both A criteria together with B3 to B6, or of criterion A1 together with B1 to B6. The criteria is as follows: A1. Platelet count > 450 × 103/µL for at least 2 months. A2. Acquired V617F JAK2 mutation present B1. No cause for a reactive thrombocytosis normal inflammatory indices B2. No evidence of iron deficiency stainable iron in the bone marrow or normal red cell mean corpuscular volume B3. No evidence of polycythaemia vera hematocrit < midpoint of normal range or normal red cell mass in presence of normal iron stores B4. No evidence of chronic myeloid leukemia But the Philadelphia chromosome may be present in up to 10% of cases. Patients with the Philadelphia chromosome have a potential for the development of acute leukemia, especially acute lymphocytic leukemia. B5. No evidence of myelofibrosis no collagen fibrosis and ≤ grade 2 reticulin fibrosis (using 0–4 scale) B6. No evidence of a myelodysplastic syndrome no significant dysplasia no cytogenetic abnormalities suggestive of myelodysplasia

So, basically she needs a good peripheral smear, Iron studies and JAK2 mutation, and later a bone marrow biopsy ?

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This Might be a case of Essential Thrombocytosis ( ET) ( Long History of Persistently elevated platelets) However , Essential Thrombocytosis is a diagnosis of exclusion and requires to rule out all causes of Reactive Thrombocytosis and Other Myeloproliferative Neoplasms with Thrombocytosis before Rendering the diagnosis as per WHO Recommendations( Criteria Listed By Dr Viral Sir) - There is no one specific confirmatory test or Genetic mutation Also Clinical Correlation is Recommended - Headaches, Neurological Impairments, Visual Disturbances , Dizziness, Bleeding Episodes The Bone Marrow Biopsy posted shows Megakaryocytic Hyperplasia and Abnormal Clustering of Megakaryocytes Adv Reticulin stain ( Rule out Myelofibrosis) Other Bone Marrow Biopsy Features Include - Giant Megakaryocytes - Dysplastic Megakaryocytes - Multilobated Megakaryocytes

Highest possibility of Essential Thrombocytopenia.. Second line of investigation is bone marrow Biopsy..

Iron deficiency anemia. Need serum creatinine and BUN levels.

Creatinine and BUN levels are normal. Serum Iron studies pending.

Essential Thrombocythemia. Kindly repeat TPC n BM study after a course of therapy.

Reactive thrombocytosis- 1) chronic inflammatory ds 2) hemolytic aneanmia 3) malignant ds Malignant thrombocytosis 1) CML 2) essential thrombocytopenia 3) polycythemia rubra vera

Complete haemogram needed.To rule out myeloroliferative disorder. Clinical history and physical examination finding required.

CMPD ( essential thrombocythemia) based on increased megakaryocytes, clustering of megakaryocytes and hyperlobulated megakaryocytes and retained fat spaces)

Even I am seeing this a reactive thrombocytosis.

Thank you all for taking part in the discussion.

Sir Please let us have iron studies reports.

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