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How I treat essential thrombocythemia

Elisa Rumi and Mario Cazzola

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  • RE: Pitfalls in the diagnostic approach of thrombocytosis
    • Andreas Holbro, Hematologist Division of Hematology, University Hospital Basel, Switzerland
    • Other Contributors:
      • Thomas Volken, Statistician
      • Andreas S Buser, Hematologist
      • Jörg P Sigle, Hematologist
      • Jörg P Halter, Hematologist
      • Jakob R Passweg, Hematologist
      • André Tichelli, Hematologist
      • Laura Infanti, Hematologist

    We read with great interest the article by the two experts Rumi and Cazzola appeared in the How I Treat section of Blood. Their proposed diagnostic workup (Table 2) and algorithm (Figure 1) includes evaluation of body iron status. Interestingly, this approach follows other guidelines1 and considers the wide differential diagnosis of reactive thrombocytosis. Iron deficiency is considered a frequent cause of thrombocytosis and therefore mentioned both in internal medicine (Harrison’s) as in specialized and well-known hematology textbooks.2,3 This paradigm, which still belongs to the classical education of internal medicine specialists and hematologists, should however be critically re-evaluated. In our recently published article4 we evaluated more than 130’000 blood counts and ferritin measurements in a homogeneous population of healthy blood donors. Contrary to existing paradigms, no correlation between serum ferritin level and platelet count was observed, even after adjusting for different co-variables. This finding has to be confirmed in subjects with a medical condition, including patients with severe iron deficient anemia. However, in severe iron deficiency microcytic anemia is the leading clinical finding. In patients with inflammation and patients with combined iron deficiency and anemia of chronic disease, reactive thrombocytosis may be caused by the inflammatory background.5
    In conclusion, although iron status may be helpful in the diagnosis of myeloproliferat...

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    Conflict of Interest:
    None declared.