emDocs - February 9, 2017 - Authors: Fujimoto J and Repanshek Z
Edited by: Koyfman A and Long B
"Pearls and Pitfalls
- In the ED, we must try to differentiate myeloproliferative/clonal thrombocytosis from secondary/reactive thrombocytosis.
- Reactive thrombocytosis may be secondary to trauma/surgery, splenectomy, infection or inflammation, blood loss, malignancy, medication use, etc. Reactive thrombocytosis tends to be transient, whereas clonal thrombocytosis is sustained. Platelet count does NOT help distinguish the two!
- Even in cases of extreme thrombocytosis, treatment of reactive thrombocytosis with antiplatelets or cytoreductive agents is NOT recommended.
- Given the relatively high incidence of thrombotic complications in essential thrombocythemia, high-risk, asymptomaticpatients should be treated prophylactically with antiplatelet agents + cytoreductive agents.
- Essential thrombocythemia patients with acute thrombotic complications require treatment with a cytoreductive agent, anticoagulation, aspirin, and possibly apheresis."