Etiologies of Extreme Thrombocytosis: A Contemporary Series

Ronan W. Hsieh, Aishwarya Ravindran, Christopher C. Hook, Kebede Begna, Aneel Arjun Ashrani, Rajiv K. Pruthi, Ariela L. Marshall, William Hogan, Mark R Litzow, James Hoyer, Jennifer Oliveira, Prakash Vishnu, Timothy G. Call, Aref Al-Kali, Mrinal M Patnaik, Naseema Gangat, Animesh D Pardanani, Ayalew Tefferi, Ronald S. Go

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Abstract

Objective: To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. Patients and Methods: We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. Results: A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. Conclusion: Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.

Original languageEnglish (US)
Pages (from-to)1542-1550
Number of pages9
JournalMayo Clinic proceedings
Volume94
Issue number8
DOIs
StatePublished - Aug 1 2019

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Thrombocytosis
Hematologic Neoplasms
Outpatients
Inpatients
Splenectomy
Platelet Count
Precipitating Factors
Neoplasms
Reading
Iron

ASJC Scopus subject areas

  • Medicine(all)

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Etiologies of Extreme Thrombocytosis : A Contemporary Series. / Hsieh, Ronan W.; Ravindran, Aishwarya; Hook, Christopher C.; Begna, Kebede; Ashrani, Aneel Arjun; Pruthi, Rajiv K.; Marshall, Ariela L.; Hogan, William; Litzow, Mark R; Hoyer, James; Oliveira, Jennifer; Vishnu, Prakash; Call, Timothy G.; Al-Kali, Aref; Patnaik, Mrinal M; Gangat, Naseema; Pardanani, Animesh D; Tefferi, Ayalew; Go, Ronald S.

In: Mayo Clinic proceedings, Vol. 94, No. 8, 01.08.2019, p. 1542-1550.

Research output: Contribution to journalArticle

Hsieh, RW, Ravindran, A, Hook, CC, Begna, K, Ashrani, AA, Pruthi, RK, Marshall, AL, Hogan, W, Litzow, MR, Hoyer, J, Oliveira, J, Vishnu, P, Call, TG, Al-Kali, A, Patnaik, MM, Gangat, N, Pardanani, AD, Tefferi, A & Go, RS 2019, 'Etiologies of Extreme Thrombocytosis: A Contemporary Series', Mayo Clinic proceedings, vol. 94, no. 8, pp. 1542-1550. https://doi.org/10.1016/j.mayocp.2019.01.041
Hsieh, Ronan W. ; Ravindran, Aishwarya ; Hook, Christopher C. ; Begna, Kebede ; Ashrani, Aneel Arjun ; Pruthi, Rajiv K. ; Marshall, Ariela L. ; Hogan, William ; Litzow, Mark R ; Hoyer, James ; Oliveira, Jennifer ; Vishnu, Prakash ; Call, Timothy G. ; Al-Kali, Aref ; Patnaik, Mrinal M ; Gangat, Naseema ; Pardanani, Animesh D ; Tefferi, Ayalew ; Go, Ronald S. / Etiologies of Extreme Thrombocytosis : A Contemporary Series. In: Mayo Clinic proceedings. 2019 ; Vol. 94, No. 8. pp. 1542-1550.
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abstract = "Objective: To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. Patients and Methods: We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. Results: A total of 44,490 patients had thrombocytosis, and 305 patients (0.7{\%}) had EXT. In 242 patients (79.3{\%}), EXT was multifactorial. Surgical complications (54.1{\%}) and hematologic malignancies (27.9{\%}) were the 2 most dominant causes. Thirty-eight patients (12.5{\%}) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9{\%}), concurrent/previous splenectomy (50.5{\%}), and infections (44.9{\%}) were the most common causes, whereas hematologic malignancies (56.9{\%}), iron deficiency (36.7{\%}), and previous splenectomy (28.4{\%}) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9{\%} vs 16.8{\%}), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6{\%} vs 8.2{\%}). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. Conclusion: Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.",
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AU - Hook, Christopher C.

AU - Begna, Kebede

AU - Ashrani, Aneel Arjun

AU - Pruthi, Rajiv K.

AU - Marshall, Ariela L.

AU - Hogan, William

AU - Litzow, Mark R

AU - Hoyer, James

AU - Oliveira, Jennifer

AU - Vishnu, Prakash

AU - Call, Timothy G.

AU - Al-Kali, Aref

AU - Patnaik, Mrinal M

AU - Gangat, Naseema

AU - Pardanani, Animesh D

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AU - Go, Ronald S.

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N2 - Objective: To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. Patients and Methods: We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. Results: A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. Conclusion: Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.

AB - Objective: To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. Patients and Methods: We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. Results: A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. Conclusion: Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.

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