Case Challenges

A young mother presents with an elevated platelet count

photo---Photomicrograph of 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.

chart

What’s your diagnosis?

A. Iron deficiency anemia
B. Reactive thrombocytosis
C. Primary thrombocythemia
D. Myelodysplastic syndrome

Click HERE for the answer.

photo---Photomicrograph of 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.

chart

What’s your diagnosis?

A. Iron deficiency anemia
B. Reactive thrombocytosis
C. Primary thrombocythemia
D. Myelodysplastic syndrome

Click HERE for the answer.