Essential Thrombocythaemia
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Chronic myeloproliferative disorder, persistent increase in platelet count. About half of cases are discovered incidentally on FBC and the other half become symptomatic – typically with thrombus formation.

  • Associated with thrombotic or haemorrhagic complications, average age 60 years
  • Good prognosis, risk of transformation to myelofibrosis and AML
  • Symptoms: may be asymptomatic, burning on the soles and palms, cold peripheries, headache, dizziness
  • Occlusion of arterioles: ischaemia, gangrene or acrocyanosis.
  • Haemorrhagic complications: ecchymosis, epistaxis, menorrhagia and GIT haemorrhage.
  • Splenomegaly unusual, may be painful splenic infarction
  • Platelet count usually >600×109/l
  • Diagnosis of exclusion (rule out infection, inflammation, iron deficiency, malignancy)
  • Investigations: normal ESR, plasma viscosity and fibribnogen levels
  • 50% have acquired JAK2 mutation.
  • Bone marrow examination: exclude CML, myelofibrosis and myelodysplasia, check iron stores
  • Treatment: hydroxycarbamide and aspirin is given in high risk cases (elderly, platelets >1500×109/l or previous thromboembolic events)
  • Low-dose asprin alone in lower risk patients, interferon given in pregnancy
Histopathology of a bone marrow aspirate of a patient with essential thrombocythaemia.
Histopathology of a bone marrow aspirate of a patient with essential thrombocythaemia. This file is taken from wikimedia commons and is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license.

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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