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A 7 LJ-year-old male with h istory of coronary and peripheral arterial disease presents to the emergency departmen t complaining of a painful. blue. fourth righ t toe . Patien t reports progressively worsening dark blue discoloration over the last 3 days. Patien t also reports several mon ths of burning sensation in h is hands and feet and left upper quadran t discom fort. Laboratory workup reveals leukocyte count of 1 5 .200/,LLL. he-moglobin of 1 LJ.6 g/d l. and platelet count of 82 5 .000/,LLL. Peripheral blood smear and bone marrow aspirate are shown below.
What is the most likely diagnosis?
- Reactive thrombocytosis
- Iron deficiency
- Essential thrombocytosis
Medicine
C. Patient presents with elevated platelet and leukocyte counts and normal hemoglobin levels. Peripheral slide review reveals evidence of giant platelets with variable granulation. Bone marrow biopsy reveals megakaryocyte hyperplasia with clustering. This presentation is most consis-tent with essential thrombocytosis (ET). Iron-deficiency anemia and underlying conditions can be associated with secondary thrombocytosis; however, giant platelets with variable granules would not be expected. Clustering of megakaryocytes would also not be expected in secondary thrombocytosis. Normal hemoglobin level argues against underlying iron deficiency.
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