C-Mannosyl tryptophan is a novel biomarker for thrombocytosis of myeloproliferative neoplasms.

C-Mannosyl tryptophan (CMW), a unique glycosylated amino acid, is considered to be produced by degradation of C-mannosylated proteins in living organism. Although protein C-mannosylation is involved in the folding and secretion of substrate proteins, the pathophysiological function in the hematological system is still unclear. This study aimed to assess CMW in the human hematological disorders. The serum CMW levels of 94 healthy Japanese workers were quantified using hydrophilic interaction liquid chromatography. Platelet count was positively correlated with serum CMW levels. The clinical significance of CMW in thrombocytosis of myeloproliferative neoplasms (T-MPN) including essential thrombocythemia (ET) were investigated. The serum CMW levels of the 34 patients with T-MPN who presented with thrombocytosis were significantly higher than those of the 52 patients with control who had other hematological disorders. In patients with T-MPN, serum CMW levels were inversely correlated with anemia, which was related to myelofibrosis (MF). Bone marrow biopsy samples were obtained from 18 patients with ET, and serum CMW levels were simultaneously measured. Twelve patients with bone marrow fibrosis had significantly higher CMW levels than 6 patients without bone marrow fibrosis. Collectively, these results suggested that CMW could be a novel biomarker to predict MF progression in T-MPN.

Pseudonormokalemia case report - What does it mean to have normal blood potassium?

This case report describes a case of pseudonormokalemia, true hypokalemia. Often, only laboratory values outside the normal range gain attention and false normal results are at risk of not being noticed. However, a disease state may be masked by another pathological process. Here, a 50-year old male was admitted to the Department of Internal Medicine due to sepsis from a dental infection. Initially, serum potassium measurement revealed a normal value of 4 mmol/L (reference interval 3.8-5.1 mmol/L). Thrombocyte number was above 500x109/L. Due to our policy to recommend a repeated measurement of potassium in whole blood or heparin plasma if a patient has thrombocytosis, pseudonormokalemia was identified because the heparin plasma potassium value was only 2.9 mmol/L (reference interval 3.5-4.8 mmol/L). The physiological difference between serum and plasma concentration is no more than 0.3 mmol/L. In this case, potassium concentration were falsely elevated in the serum sample, probably caused by the high number of platelets releasing potassium during clotting. Interpretative comments in patients with thrombocytosis over 500x109/L recommending plasma potassium measurement are helpful. The best way to eliminate pseudohyperkalemia and pseudonormokalemia phenomena caused by thrombocytosis is to completely change towards heparin plasma as the standard material.

Distinctive patterns of sequential platelet counts following blunt traumatic brain injury predict outcomes.

OBJECTIVE: To determine the role of platelet counts in the context of the decision to treat patients with non-compounded, non-surgically-treated blunt traumatic brain injury (NCNS-bTBI) with anticoagulants/antiaggregants. METHODS: A retrospective analysis of 141 anticoagulants/antiaggregants-naïve patients with NCNS-bTBI. Changes in PT-INR and prolonged aPTT were examined and correlated with Marshall and Rotterdam scores, clinical and neuroradiological outcomes. RESULTS: Three groups of platelet counts were identified. Group 1 (83% of patients) had normal platelet counts (150,000-450,000 platelets/mm3) from admission to discharge. Group 2 (13%) developed transient thrombocytopenia (<150,000 platelets/mm3) 2-3 days post-trauma. Group 3 (4%) developed extreme thrombocytosis > 1,000,000/mm3 platelets 6-9 days post-trauma. Neither acute coagulopathy of trauma nor progressive hemorrhagic insults followed NCNS-bTBI. Moreover, while patients with thrombocytosis/extreme thrombocytosis presented with a worse Glasgow coma score (GCS) on admission (8.8 ± 2.9 vs. 13 ± 2, p < 0.01) and had longer hospitalization (13.5 ± 10.4 vs. 4.5 ± 2.1 days), their improvement at discharge was the highest (delta GCS, 4 ± 2.8 vs. 1.2 ± 2.1, p = 0.05). Traumatic subarachnoid hemorrhage was associated with isolated thrombocytosis and 'best improvement.' No thromboembolic or hemorrhagic complications occurred. CONCLUSION: NCNS-bTBI, thrombocytosis was correlated with better outcomes and was not associated with an increased risk for developing thromboembolism or hemorrhage, precluding the immediate need for any additional antiaggregates.

An Introduction to the Complete Blood Count for Clinical Chemists: Platelets.

BACKGROUND: The most ordered laboratory test worldwide is the complete blood count (CBC). CONTENT: In this primer, an introduction to platelet testing in the context of the CBC is provided with a discussion of the laboratory evaluation of platelet abnormalities including thrombocytopenia and thrombocytosis. SUMMARY: As clinical chemists continue to be tasked to direct laboratories outside of the traditional clinical chemistry sections such as hematology, expertise must be developed. This primer is dedicated to that effort.

Artrite reumatoide do tipo EORA com trombocitose significativa: relato de caso / Elderly-onset rheumatoid arthritis with significant thrombocytosis: a case report

Este relato teve como objetivo apresentar um caso de elderly onset rheumatoid arthritis associada à trombocitose reacional significativa. À admissão, o paciente apresentava quadro de poliartrite de pequenas e grandes articulações associado à rigidez matinal. Após exames solicitados, evidenciaram-se trombocitose de 1.697.000 cel./mm³ e anticorpos antipeptídeos citrulinados positivos, sendo diagnosticado com artrite reumatoide do tipo elderly onset rheumatoid arthritis.

This report aimed at presenting a case of elderly-onset rheumatoid arthritis associated with significant reactive thrombocytosis. On admission, the patient presented polyarthritis of small and large joints associated with morning stiffness. After the performance of the requested tests, thrombocytosis of 1,697,000 cells/mm3 and positive anti-CCP were evidenced, and the patient was diagnosed with elderly-onset rheumatoid arthritis.

Trombocitosis en la edad pediátrica / Thrombocytosis in paedriatric patients

El valor normal de plaquetas varía entre 150,000 y 450,000 x mm al cubo. Se define trombocitosis como un recuento mayor de 600,000. Pueden ser primarias, por un trastorno mieloproliferativo o secundarias a un gran número de patologías. Objetivos: conocer en nuestro medio la frecuencia de ambos tipos de trombocitosis, describir las patologías asociadas y relacionar la magnitud de la trombocitosis con los diferentes diagnósticos. Material y métodos: se analizaron 18,000 hemogramas realizados entre enero y diciembre de 1998, en el Hospital Roberto del Río. Se evaluó sexo, recuento de plaquetas y leucocitos, hematocrito, hemoglobina, VCM, CHCM y diagnósticos. Resultados: se encontró trombocitosis en 584 exámenes (3,24 por ciento). Se evaluaron 334 fichas, el 62 por ciento eran de sexo masculino. El 0,9 por ciento presentó cifras de plaquetas > 1,000,000 x mm al cubo (dos casos fueron trombocitosis primarias: trombocitemia esencial y leucemia mieloide crónica y un caso de meningitis bacteriana). Las trombocitosis secundarias se asociaron a: infecciones (48,8 por ciento), principalmente respiratorias, deficiencia de hierro (18,6 por ciento) y daño tisular (12,6 por ciento). Conclusiones: la frecuencia de trombocitosis en niños es baja. Cuando la trombocitosis es menor de 1,000,000 x mm al cubo debe sospecharse una etiología secundaria

Trombositosis en pacientes con linfoma / Thrombocytosis in lymphoma patients

La trombocitosis asociada a linfoma ha sido descrita en forma muy esporádica, por esta razón hicimos un estudio retrospectivo en 59 pacientes con linfoma. En 24 (40%) se encontró al menos 2 determinaciones de plaquetas mayores de 450.000.mm 3, 13 (54%) con Enfermedad de Hodgkin (EH) y 11 (46%) con linfomas No-Hodgkin (LNH). La mayoría de los pacientes con LNH (72%) correspondían a linfomas de intermedio y alto grado de malignidad. El estadio se pudo precisar en el 75% de los pacientes y de éstos el 95% correspondían a estadios III o IV. En el 87% de los enfermos la trombocitosis coincidió con: actividad de la enfermedad 70%, infección 10%, actividad e infección 20%. Se concluye: 1.- La trombocitosis es relativamente frecuente durante la evolución de los pacientes con linfoma, 2.- Generalmente se encuentra en estadios avanzados, 3.- Se asocia a actividad de la enfermedad o infección

Trombocitose e doença de Crohn / Thrombocytosis and Crohn disease

A correlaçäo entre trombocitose e atividade da doença de Crohn (DC) tem sido constatada por alguns autores. Entretanto, esta observaçäo näo tem sido extensamente utilizada pela existência de comprovaçöes limitadas. Assim, os autores analisaram, retrospectivamente, os dados dos últimos 30 pacientes atendidos na Disciplina de Gastroenterologia do Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, e na clínica privada de um dos autores (A.B.). Levou-se em consideraçäo a contagem de plaquetas (método de Brecher-Cronkite; valores normais 200.000 a 400.000 plaquetas/mm3) e o índice clínico de atividade da DC segundo os critérios de Harvey e Bradshaw. Onze pacientes (37%) apresentaram trombocitose (x=500.818 + ou - 56.845) e o valor médio do índice clínico de atividade desse grupo foi 8,6 (intervalo de confiança: 6-13). Dezenove pacientes (63%) näo apresentaram trombocitose (267.789 + ou - 62.124) e o seu valor médio de atividade foi 5,7 (intervalo de confiança: 2-11). Diferença estatisticamente significante foi verificada entre os valores médios dos índices clínicos de atividade dos dois grupos (z=2,84, para alfa < ou = 0,05), bem como entre as médias do número de plaquetas/mm3 (z = 4,5, para alfa < ou = 0,05). Näo houve relaçäo estatisticamente significante entre trombocitose e formas íleo-cólica, jejuno-ileal e cólica da DC. Entretanto, dos nove pacientes da casuística com forma ileal, oito (88%) näo apresentaram trombocitose e tiveram índices de atividade < ou = 6. Os possíveis mecanismos fisiopatológicos da trombocitose na DC säo comentados e revisados. A relaçäo entre trombocitose e a atividade da DC, observada na presente casuística, näo constitui, certamente, elemento diagnóstico para a afecçäo, mas associadamente ao quadro clínico, pode representar importante parâmentro para indicar a atividade da doença