Dr. Abdul Aziz Khan
Medical oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am enquiring on behalf of my partner. He has been having slightly raised WBC for a number of years. In the recent months, platelet count is continuously rising. As you can see in the blood test reports platelet count was 450 before four months, 496 before three months, and 570 this month. WBC remains slightly raised but does not seem to be increasing. His symptoms are fatigue and occasional itchy skin. He has been tested for JAK2, CALR, and BCR-ABL mutations which are all negative. With something like ET how quickly does platelet count rise? How likely is this to be MPN? Or could it be a result of smoking? He was a smoker for 35 years.
Hello,
Welcome to icliniq.com.
Thank you for your query.
WBC (white blood cells) has become 11000 this month which is normal and the upper limit of Hb (hemoglobin) is also normal. Platelet counts are going up as you mentioned. It may be due to smoking because Hb and HCT (hematocrit) are at the upper limit of normal values. To rule out secondary polycythemia we need to follow up every two to three months for about six months. Let us hope that the platelet count may also come down like WBC. If they increase persistently over the next three months then it is better to do a peripheral blood film to look for any possibilities of essential thrombocytosis or polycythemia. Once the platelet level goes above 700, I suggest you to start tablet Asprin 100 mg daily until we know the cause. Kindly consult a specialist, talk to them, and take medications with their consent.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
The platelets have only started rising in the last three to four months. Typically, how quickly and by how much should platelet count rise with ET or PV? For example, it is slow over a period of time. Also is it likely to be a gene mutation associated with these conditions? Another symptom that he has is cold fingers. Does this indicate ET or is it more likely to be as a result of smoking as both Hb and HCT are on the upper end?
Hello,
Welcome back to icliniq.com.
Typically in ET (essential thrombocythaemia), there is a progressive increase over many months. That is why we monitor over six months period. To rule out ET we need to do a bone marrow examination. Gene mutation is JAK 2 for PV (polycythemia vera). As all of these can be due to smoking, it is better to avoid smoking and see the response. At this stage, it is difficult to differentiate them as there is no diagnostic test for ET.
I hope this has helped you.
Thank you.
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Medical oncology
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