Raised Platelets (Thrombocytosis)

Investigation and Referral Guidance

 

Refer through Choose and Book if:

1)         Platelet count > 500 x 10⁹/l persisting for > 6 months

and

There is no reactive cause

and

Iron stores are normal

 

Or

2)         Platelet count > 450 x 10⁹/l

and

there is other evidence of a myeloproliferative disorder

 

Intermediate and difficult cases may be referred for advice through choose and book.

 

 

Secondary (reactive) thrombocytosisis common

Causes include:

Infection

Inflammation

Iron deficiency

Tissue damage (eg recent surgery, injury)

Haemolysis

Severe exercise

Malignancy (and rebound after chemotherapy)

Hyposplenism (splenectomy, coeliac disease)

 

and other causes of an acute phase response.

These are usually, but not always, characterized by an elevated C-reactive protein.

 

Primary (myeloproliferative)‘essential thrombocytosis’ is rare and is suggested by:

Splenomegaly

Thromboembolism

Raised red cell count (+/-  hypochromic indices suggesting iron deficient polycythaemia)

Unexplained neutrophil leucocytosis

 

Patients are at risk of both thrombosis and of haemorrhage.

Recommended initial examination and tests:

History and examination to distinguish potential primary and secondary causes

FBC and blood film
CRP
Ferritin
Urate

 

Initial management

The management of secondary thrombocytosis is the management of the underlying disorder.

Correct and investigate iron deficiency.

Beware iron deficient polycythaemia.

 

 

 

Date reviewed               30/6/2019

Next review due             30/6/2020

Sifter name                   Dr Michele Sharkey

 

Awaiting Consultant Approval

 

 

Version 1.2