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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. Collitisa. Pri. Thrombocythaemia (ET)
b. CTD e.g. Rh. Arthritis.b. PRV
c. Malignancy e.g. Hodgkin’s dis.c. Myelofibrosis.
d. Acute Haemolysisd. 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.

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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