A patient has a platelet count of 1200 ´ 109/L. Many platelets are giant and have abnormal shapes. A mild anemia is present. The bone marrow has increased megakaryocytes in clusters; iron stores are present. Which of the following is most likely?
a. Essential thrombocythemia
b. Chronic myelogenous leukemia
c. Thrombocytosis secondary to blood loss
d. Polycythemia vera
ANS: A
Platelet counts are often over 1000 ´ 109/L in essential thrombocythemia. Polycythemia vera also has an elevated platelet count but usually not in this range. In addition, a mild anemia is present in the presence of iron stores; this rules out polycythemia vera. Although the platelet count is usually elevated in the chronic phase of chronic myelogenous leukemia, it is neither this high nor would it be this elevated in thrombocytosis secondary to blood loss.
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