letter from consultation

[Carthe]

just had my letter from my meeting last week … still awaiting diagnosis but please I welcome your thoughts on this…..

I note the serial blood counts that you kindly sent through from a number of different laboratories.

These demonstrate a mild thrombocytosis, normal renal and liver function tests, normal CRP and normal iron stores/ ferritin.

The Hb on the most recent blood count was 154g/L with a haematocrit of 0.47 The WCC was normal.

On screening today, there is no clear reactive cause for the mild thrombocytosis. I note an autoimmune profile was normal.

You have a history of some tinnitus and migraine type episodes in the past. You have no constitutional symptoms.

As you know the possibilities are:

1) this represents a reactive process, the aetiology of which is unclear

2) there may be a MPN and you are awaiting the mutation screen and thereafter need to consider whether a BM biopsy is required

3) this is a thrombocytosis of undetermined significance and can be followed periodically with FBC to ascertain trends.

[hunter5582]

It sounds like confirmation of what you already know. In the absence of an identified cause of reactive thrombocytosis, you will need to wait on the genetic tests to make the next set of decisions. If you are positive for a driver mutation, the answer would be more clear. If you are negative for driver mutations, then you are going to have to decide whether a BMB is warranted. I do not think there is a clear choice here. It may be more about your preference in how to handle the assessment process.

Wishing you success in finding an answer.

[Carthe in reply to hunter5582]

thanks as always hunter - and the hct and hb? Are they high or in ‘normal’ range?

[hunter5582]

You would have to check the reference range being used by your lab to answer that question. The reference range varies by lab.

The 2016 WHO diagnostic criteria for PV include these criteria.

Hemoglobin > 16.5 g/dL in men and > 16 g/dL in women, or hematocrit > 49% in men and > 48% in women, or red cell mass > 25% above mean normal predicted value.

Your HGB and HCT fall below these levels. You would not meet criteria to consider a diagnosis of PV based on these numbers.

All the best.