Results of Follow-up Tests and More Testing

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The page below is a sample from the LabCE course Case Studies in Hematology - Malignant WBC Disorders. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Results of Follow-up Tests and More Testing

Both the inflammatory markers and the iron panel all came back within the normal range. These results helped rule out secondary causes of thrombocytosis (elevated platelets), such as iron deficiency (even though the patient was not anemic and had a normal MCV) and various chronic inflammatory states, other malignancies, etc. The repeat platelet count was 720 x 109 /L.
Because the condition could be transitory, a repeat platelet count in one month and thrombopoietin (TPO) levels were ordered to rule out possible familial thrombocytoses. Thrombopoietin is the hormone that stimulates platelet production.
One month later, the TPO levels were within the normal range, and the platelet count was higher at 780 x 109 /L. The peripheral blood smear also showed a very large number of mainly normal-appearing platelets (right image). Additionally, the patient reported experiencing some numbness in the toes and having had night sweats a few nights during the last month. The next step was to investigate a possible myeloproliferative neoplasm (MPN) diagnosis, so a bone marrow smear and biopsy were ordered, as well as genetic testing.