An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis
Background. Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation...
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Advances in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2024/3056216 |
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| author | Ala Almanaseer Benjamin Chin-Yee Jenny Ho Alejandro Lazo-Langner Laila Schenkel Pratibha Bhai Bekim Sadikovic Ian H. Chin-Yee Cyrus C. Hsia |
| author_facet | Ala Almanaseer Benjamin Chin-Yee Jenny Ho Alejandro Lazo-Langner Laila Schenkel Pratibha Bhai Bekim Sadikovic Ian H. Chin-Yee Cyrus C. Hsia |
| author_sort | Ala Almanaseer |
| collection | DOAJ |
| description | Background. Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. Methods and Results. All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p<0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p<0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p<0.01). Conclusion. A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing. |
| format | Article |
| id | doaj-art-3d6ed8ec8ad4402b9f3ce82bd6c7a757 |
| institution | Kabale University |
| issn | 1687-9112 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Hematology |
| spelling | doaj-art-3d6ed8ec8ad4402b9f3ce82bd6c7a7572025-02-03T07:23:38ZengWileyAdvances in Hematology1687-91122024-01-01202410.1155/2024/3056216An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary ThrombocytosisAla Almanaseer0Benjamin Chin-Yee1Jenny Ho2Alejandro Lazo-Langner3Laila Schenkel4Pratibha Bhai5Bekim Sadikovic6Ian H. Chin-Yee7Cyrus C. Hsia8Department of MedicineDivision of HematologyDivision of HematologyDivision of HematologyMolecular Diagnostic DivisionMolecular Diagnostic DivisionDepartment of Pathology and Laboratory MedicineDivision of HematologyDivision of HematologyBackground. Thrombocytosis is a common reason for referral to Hematology. Differentiating between secondary causes of thrombocytosis and essential thrombocythemia (ET) is often clinically challenging. A practical diagnostic approach to identify secondary thrombocytosis could reduce overinvestigation such as next generation sequencing (NGS) panel. Methods and Results. All adult patients with thrombocytosis (≥450 × 109/L) who underwent molecular testing at a single tertiary care centre between January 1, 2018 and May 31, 2021 were evaluated. Clinical and laboratory variables were compared between patients with secondary thrombocytosis vs. ET. Clinical variables included smoking, thrombosis, splenectomy, active malignancy, chronic inflammatory disease, and iron deficiency anemia. Laboratory variables included complete blood count (CBC), ferritin, and myeloid mutations detected by NGS. The overall yield of molecular testing was 52.4%; 92.1% of which were mutations in JAK2, CALR, and/or MPL. Clinical factors predictive of ET included history of arterial thrombosis (p<0.05); active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency were associated with secondary thrombocytosis (p<0.05). A diagnosis of ET was associated with higher hemoglobin, mean corpuscular volume (MCV), red cell distribution width (RDW), and mean platelet volume (MPV), while secondary thrombocytosis was associated with higher body mass index, white blood cells, and neutrophils (p<0.01). Conclusion. A practical approach to investigating patients with persistent thrombocytosis based on clinical characteristics such as active malignancy, chronic inflammatory disease, splenectomy, and iron deficiency may assist in accurately identifying patients more likely to have secondary causes of thrombocytosis and reduce overinvestigation, particularly costly molecular testing.http://dx.doi.org/10.1155/2024/3056216 |
| spellingShingle | Ala Almanaseer Benjamin Chin-Yee Jenny Ho Alejandro Lazo-Langner Laila Schenkel Pratibha Bhai Bekim Sadikovic Ian H. Chin-Yee Cyrus C. Hsia An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis Advances in Hematology |
| title | An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis |
| title_full | An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis |
| title_fullStr | An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis |
| title_full_unstemmed | An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis |
| title_short | An Approach to the Investigation of Thrombocytosis: Differentiating between Essential Thrombocythemia and Secondary Thrombocytosis |
| title_sort | approach to the investigation of thrombocytosis differentiating between essential thrombocythemia and secondary thrombocytosis |
| url | http://dx.doi.org/10.1155/2024/3056216 |
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