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Essential thrombocytosis

Essential thrombocytosis

There are 2 types of thrombocytosis:
1. Reactive (most Common) 2. Clonal
a. Chr. Infl. Dis. E.g. ulc. Collitis a. Pri. Thrombocythaemia (ET)
b. CTD e.g. Rh. Arthritis. b. PRV
c. Malignancy e.g. Hodgkin’s dis. c. Myelofibrosis.
d. Acute Haemolysis d. CML.
e. Fe. Def. An. e. MDS.
f. GI bleeding
g. Post – splenectomy

Clinically :

Those of the underlying dis.
Haemostasis rarely affected
PRV, ET, Myelofibrosis, may present with thrombosis and rarely bleeding
Reactive : small plat. No splenomegally.

essential thrombocytosis
Plat. Function disorders

1. Acquired

  • a. Iatrogenic
    Aspirin – Cyclo – Oxygenase inhibitor
    Clopidogrel – ADP receptor inhibitor
    Abciximab – Gp 11 b / 111 a inhibitor
    Tirofiban – Gp 11 b / 111 a inhibitor
    Dipyridamol – phosphodi esterase inhibitor
  • b. Antibiotics: Penicillin, Cephalosporines
  • c. Heparin
  • d. CRF
  • e. Myelofibrosis
  • f. Paraproteinaemia
  • g. CTD

2. Congenital

  • a. Glanzmann’s thromboasthenia ‐ Def. of GP 11b / 111a
    AR, bleeding variable, often severe.
  • b. Bernard – Soulier dis. def. of GP 1b. AR
  • c. Defective plat. Granules – deficiency of dense granules
    (b & c cause mild bleeding e.g. after trauma or surgery, rarely spont.)

Management :

Local mechanical pressure .
Antifibrinolytic e.g. Tranexamic acid may be useful .
Plat. Transf. in severe bleeding.
Recombinent FVIIa in resistant bleeding in Glanzmann.

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