Decoding High Platelet Count: Considerations and Assessment

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Dear #medicine residents When you are confronted with a High Platelet Count How to make sense out of it Keep reading #medtwitter #MedEd

Common Things are Common First! Think Secondary Causes 1️⃣ Infection 2️⃣ Inflammation 3️⃣ Recent Surgery / Trauma 4️⃣ Medications: Steroids 5️⃣ Connective Tissue Disorders 6️⃣ Malignancy

When You Assess Clinically / Think Logically 1️⃣ Take a Good History 2️⃣ Medications History 3️⃣ Bleeding / Menstrual History 4️⃣ Microvascular Symptoms 5️⃣ Any Previous Surgery/VTE/Stroke 6️⃣ Red Flag Symptoms / B Symptoms 7️⃣ Examination: Assess for Organomegaly/Lymphadenopathy

Request The following Investigations as appropriate 1️⃣ Full Blood count 2️⃣ Blood Film 3️⃣ Urea & Electrolytes 4️⃣ Liver Function Tests 5️⃣ CRP / LDH / ESR / Autoimmune Profile 6️⃣ Ferritin / Iron Studies 7️⃣ Radiology i.e. CT Scan is needed

On a Blood Film 👉 If Hypochromic Microcytic/ Pencil Cells / Thrombocytosis ➡️ Likely IDA 👉If Reactive Features like Activated Neutrophils / Monocytes / High Platelets ➡️ Likely Infection 👉Anisothrombia / Eosinophila / Basophils ➡️ Possible MPD

Now above causes dont fit Then Ask Yourself could this be Primary Myeloproliferative Disease Then Do the Following 1️⃣ Assess Microvascular Symptoms (Pins/Needles - Hands or feet) 2️⃣ Any Previous VTE / Stroke 3️⃣ Send an Urgent EDTA Sample for JAK2/CALR/MPL 4️⃣ Refer to Haem

➡️ Urgent Referral Criteria 1️⃣ Persistent thrombocytosis >600 (>3mths apart), no reactive cause 2️⃣ Persistent thrombocytosis >450 in patients with an acute clot (arterial or venous) ➡️ Routine Referral 1️⃣ Persistent thrombocytosis >450 for at least 3 months (Nil Reactive)

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