A 17-year-old with Thrombocytosis
A 17-year-old female with no significant past medical history was referred to a hematology clinic for evaluation of thrombocytosis. High platelet count was noted on a CBC obtained during evaluation of a complicated urinary tract infection. At that time, she had a platelet count of 884 k/uL, MPV 9.3. WBC was 10.2 k/uL with 58% neutrophils, 30% lymphocytes, 9% monocytes, 2% eosinophils, and no blasts. Her hemoglobin was 14.1 g/dL with MCV of 87.4, MCH 28.6, MCHC 32.7, and RDW 12.1%. Over the next month, repeat labs demonstrated platelet counts ranging from 724 k/uL to 767 k/uL. All other WBC and RBC parameters remained stable. She presented to the pediatric hematology clinic a month later with fatigue, mild residual cough, and congestion from a recent cold. She denied any further urinary symptoms.
Review of symptoms was negative for fevers, weight loss, night sweats, dyspnea, abdominal pain, and headaches. She had no prior history of bleeding or clotting. Exam was unremarkable with no hepatosplenomegaly, lymphadenopathy, rashes, petechiae, bruising, pallor, or jaundice.
What is the next best step in management?
Katherine Mercer, MD, and Daniel McKeone, MD
Division of Pediatric Hematology/Oncology
Penn State Health Children's Hospital, Hershey, PA
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