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jueves, 9 de febrero de 2017

Thrombocytosis in the ED

emDocs
emDocs - February 9, 2017 - Authors: Fujimoto J and Repanshek Z
Edited by: Koyfman A and Long B
"Pearls and Pitfalls
  1. In the ED, we must try to differentiate myeloproliferative/clonal thrombocytosis from secondary/reactive thrombocytosis.
  2. 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!
  3. Even in cases of extreme thrombocytosis, treatment of reactive thrombocytosis with antiplatelets or cytoreductive agents is NOT recommended.
  4. Given the relatively high incidence of thrombotic complications in essential thrombocythemia, high-risk, asymptomaticpatients should be treated prophylactically with antiplatelet agents + cytoreductive agents.
  5. Essential thrombocythemia patients with acute thrombotic complications require treatment with a cytoreductive agent, anticoagulation, aspirin, and possibly apheresis."