peripheral blood film.
A 32-year-old woman is found to have an elevated platelet count
on routine complete blood count (CBC). In retrospect, near the end of her
recent, uncomplicated pregnancy, her platelet count was 578,000/µL. Her
past medical history is otherwise relatively unremarkable.
She does have occasional headaches, but these have not worsened
in frequency or intensity recently. She takes ibuprofen when these headaches
occur, but otherwise takes no medications regularly. She does not use any
herbal or other alternative remedies.
She is married and has one child, who is 6 months old. Her family
history is unremarkable for any hematologic disease. On review of systems, she
denies any visual changes, lightheadedness, abnormal sensations or other
neurologic symptoms aside from the occasional headaches noted above.
Physical examination reveals her to be a
well-appearing woman. No petechial or purpuric skin lesions are noted. There is
no lymphadenopathy and no splenomegaly. The remainder of the physical
examination is unremarkable.
Recent laboratory studies are presented in Table A.
A repeat CBC performed one month later is essentially unchanged.
The platelet count remains elevated at 625,000/ml. A photomicrograph of the
peripheral blood film is shown. A bone marrow aspirate and biopsy are performed
and reveal a normocellular marrow. Myeloid and erythroid maturation is present
without morphologic abnormalities. Megakaryocytes are increased in number and
include occasional dysplastic forms. Cytogenetics are normal.
A. Iron deficiency anemia
B. Reactive thrombocytosis
C. Primary thrombocythemia
D. Myelodysplastic syndrome
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