American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2015, 3(6), 184-186
DOI: 10.12691/ajmcr-3-6-10
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Extreme Thrombocytosis: A Unique Constellation of Reactive Thrombocytosis, Iron Deficiency Anemia and Atypical Celiac Disease

Hamza Hashmi MD1, and Umayr Azimi MD1

1Department Of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapids, Michigan

Pub. Date: May 31, 2015

Cite this paper:
Hamza Hashmi MD and Umayr Azimi MD. Extreme Thrombocytosis: A Unique Constellation of Reactive Thrombocytosis, Iron Deficiency Anemia and Atypical Celiac Disease. American Journal of Medical Case Reports. 2015; 3(6):184-186. doi: 10.12691/ajmcr-3-6-10


Reactive thrombocytosis refers to elevated platelet count in the absence of a myeloproliferative or myelodysplastic syndrome and is secondary to a medical or surgical condition. Extreme thrombocytosis (>1000) is unlikely to be autonomous in origin and an underlying reactive process should be strongly suspected. A 22 year old apparently healthy male presented with fatigue of five months duration. Labs showed marked hypochromic microcytic anemia with hemoglobin of 5 g/dL, extremely high platelet count of 1600 x 109 and undetectable ferritin. Upper and lower GI scopes failed to reveal any source of bleeding. Ultrasound abdomen revealed mildly enlarged spleen. Besides markedly increased megakaryopoesis, erythropoesis and low iron stores; bone marrow biopsy did not reveal any myelodysplasia. Patient was transfused 4 units of Packed RBC with rapid improvement of hemoglobin and platelet count within one week. Villous atrophy on duodenal biopsy and elevated tissue transglutaminase antibody levels confirmed diagnosis of celiac disease. Patient was started on iron supplements and gluten free diet. Follow up in 3 months revealed completely normal hemoglobin, ferritin level and platelet count. Extreme thrombocytosis should raise suspicion for a secondary cause rather than a primary myeloproliferative disorder. Iron deficiency anemia, a relatively rare but benign cause should be strongly considered in work up of reactive thrombocytosis. Atypical forms of celiac disease can be relatively asymptomatic. If clinical suspicion is high serum antibody assay and intestinal biopsy should be considered. The case illustrates rare constellation of extreme thrombocytosis from iron deficiency anemia in an otherwise asymptomatic celiac disease patient.

extreme thrombocytosis reactive thrombocytosis iron deficiency anemia celiac disease

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[1]  Buss DH, Cashell AW, O'Connor ML, Richards F: Occurrence, etiology and clinical significance of extreme thrombocytosis: a study of 280 cases. Am J Med 1994, 96:247-253.
[2]  Sanchez S, Ewton A: Essential thrombocythemia: a review of diagnostic and pathologic features. Arch Pathol Lab Med 2006, 130(8):1144-1150.
[3]  Halfdanarson TR, Litzow MR, Murray JA: Hematologic manifestations of celiac disease.Blood 2007, 109(2):412-421.
[4]  Schafer AI: Thrombocytosis. N Engl J Med 2004, 350(12):1211-1219.
[5]  Bilic E, Bilic E: Amino acid sequence homology of thrombopoietin and erythropoietin may explain thrombocytosis in children with iron deficiency anemia. J PediatrHematolOncol 2003, 25(8):675-676.
[6]  Akan H, Guven N, Aydogdu I, Arat M, Beksac M, Dalva K: Thrombopoietic cytokines in patients with iron deficiency anemia with or without thrombocytosis. ActaHaematol 2000, 103(3):152-156.