An asymptomatic patient on regular health checkup has platelet counts of 8,00,000. Next line of management is:
A i.e. Follow-up and observeRef: Harrison's Principles of Internal Medicine, 19th edition, page 678Explanation:An elevated platelet count in an asymptomatic patient without cardiovascular risk factors requires no therapy.When the platelet count rises above 1 x 106/pL, a substantial quantity of high-molecular-weight von Willebrand multimers are removed from the circulation and destroyed by the enlarged platelet mass, resulting in an acquired form of von Willebrand's disease.THROMBOCYTOSISThrombocytosis, also called thrombocythemia, is generally defined as a platelet count greater than a defined upper limit of normal that may vary between 350,000/pl to 600,000/pl, depending on the laboratory or medical reference. The most common cut off for normal is <450,000/pl.Elevated platelet counts are often an incidental or unexpected finding on a complete blood count (CBC) conducted to evaluate an unrelated condition.For those individuals found to have thrombocytosis without associated bleeding or thrombosis, the first challenge is to find the cause.The causes of thrombocytosis are separated into two categories:Autonomous (primary) thrombocytosisOccurs as a result of myeloproliferative disorders, myelodysplastic disorders, or rarely as a result of a hereditary condition.Reactive (secondary) thrombocytosis is:Most often a normal physiologic response to coexistent inflammatory condition (e.g., infection, chronic inflammatory condition).Management of essential thrombocytosis by risk factorsRisk categoryRisk factorsManagementLowAge <60 and no prior cardiovascular eventNil. Follow-up and observeIntermediateGeneric cardiovascular risk factorsLow dose aspirin (no consensus)HighAge >60 and/or prior cardiovascular eventsMyelosuppression + Low dose aspirin
Follow up and observe
Bone marrow biopsy
Plasmapheresis
Phelobotomy + Packed cell transfusion
Blood