Haematology profiles in patients with essential and reactive thrombocytosis

Aisyah Anwar Pallao; Sahyuddin Saleh; Femi Syahriani; Syakib Bakri; Risna Halim Mubin; Arifin Seweng

doi:10.23750/abm.2026.18576

Authors

Aisyah Anwar Pallao Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Sahyuddin Saleh Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Femi Syahriani Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Syakib Bakri Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Risna Halim Mubin Division of Tropical Infections, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Arifin Seweng Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

Keywords:

platelet distribution width (PDW), Platelets

Abstract

Background: An elevated platelet count, either primary (such as essential thrombocytosis) or secondary (such as reactive thrombocytosis), is the hallmark of thrombocytosis. These two conditions have different clinical implications and management approaches but are often difficult to distinguish clinically. Routine hematological tests, including platelet count, mean platelet volume, platelet distribution width, leukocyte count, and hemoglobin, have the potential to serve as easily accessible initial parameters to help differentiate between the two conditions. The purpose of this study is to assess how routine hematological indicators can be used to distinguish between essential thrombocytosis and reactive thrombocytosis.

Materials and Methods: A retrospective cross-sectional analytical observational study was conducted at Makassar's Dr. Wahidin Sudirohusodo General Hospital between November 2024 and January 2025. The study subjects were patients with platelet counts ≥450,000/mm³. The diagnosis of essential and reactive thrombocytosis was established based on the evaluation of thrombocytosis persistence and peripheral blood smear findings, with bone marrow aspiration used solely for diagnostic confirmation as documented in medical records.

Results: A total of 90 thrombocytosis patients were analyzed, including 37 patients ET and 53 patients RT. The mean age in ET was 41.1±11.1 years and in RT was 45.2±10.2 years. The mean WBC count was higher in ET than in RT (19.06±14.8 vs. 15.1±6.5 ×10³/µL; p=0.265). ET had significantly higher platelet counts (1,418.3±735.9 vs. 605±126.5 ×10³/µL; p<0.001) and Hb levels (13.06±2.3 vs. 8.7±1.8 g/dL; p<0.001). MPV values were slightly higher in ET (8.9±1.0 vs. 8.79±0.8 fL; p<0.001), while PDW did not differ significantly between the two groups (11.0±3.4 vs. 8.8±1.6 fL; p=0.311).

Conclusion: Hemoglobin, MPV, and platelet count were all higher in essential thrombocytosis than in reactive thrombocytosis

References

1. Babacan A, Şenol FF. Thrombocytosis in children. Rev Assoc Med Bras. 2023;69(6):16-9. doi: 10.1590/1806-9282.20230020

2. Clarke C, Hamilton W, Price S, Bailey SER. Association of non-malignant diseases with thrombocytosis: a prospective cohort study in general practice. Br J Gen Pract. 2020;70(701):E852-7. doi: 10.3399/BJGP20X713501

3. Accurso V, Santoro M, Mancuso S, et al. The essential thrombocythemia in 2020: what we know and where we still have to dig deep. Clin Med Insights Blood Disord. 2020;13. doi: 10.1177/2634853520978210

4. Lee E, Kim M, Jeon K, et al. Mean platelet volume, platelet distribution width, and platelet count, in connection with immune thrombocytopenic purpura and essential thrombocytopenia. Lab Med. 2019;50(3):279-85. doi: 10.1093/labmed/lmy082

5. Almanaseer A, Chin-Yee B, Ho J, et al. An approach to the investigation of thrombocytosis: differentiating between essential thrombocythemia and secondary thrombocytosis. Adv Hematol. 2024;2024(Cml):1-7. doi: 10.1155/2024/3056216

6. Selvaraju V, Jayaganesh J, Nikshayaa N. Platelet indices in differentiating reactive versus clonal thrombocytosis. Saudi J Pathol Microbiol. 2023;8(03):50-4. doi: 10.36348/sjpm.2023.v08i03.002

7. Altomare I, Kessler CM. Thrombocytosis: essential thrombocythemia and reactive causes. In: Kitchens CS, Kessler CM, Konkle BA, Streiff MB, Garcia DABTCH and T, eds. Elsevier; 2019. p. 346-73. doi: 10.1016/B978-0-323-46202-0.00019-4

8. Shen CL, Hsieh TC, Wang TF, Huang WH, Chu SC, Wu YF. Designing a scoring system for differential diagnosis from reactive thrombocytosis and essential thrombocytosis. Front Med. 2021;8:1-7. doi: 10.3389/fmed.2021.736150

9. Hafeez A, Khattak D, Naeem S, Robert HM, Mohsin S, Mahmood A. Platelet indices as a tool for differentiation between clonal thrombocytosis and reactive thrombocytosis. Pak Armed Forces Med J. 2023;73:79-83. doi: 10.51253/pafmj.v73iSUPPL-1.6350

10. Ozturk N, Baygutalp NK, Bakan E, Altas GF, Polat H, Dorman E. Changes in platelet parameters in leukocytosis. Pan Afr Med J. 2016;24:185. doi: 10.11604/pamj.2016.24.185.7510

11. Tekin TO, Karis D, Ates Alkan F, Cetin G, Ercan AM. Evaluation of trace elements in essential thrombocytosis and reactive thrombocytosis. J Trace Elem Med Biol. 2022;73:127034. doi: 10.1016/j.jtemb.2022.127034