Reactive Thrombocytosis: A Benign Entity?

Thrombocytosis, a condition defined as having a platelet count of more than 450,000 per microliter of blood (450x 109/L), can be either physiologic in nature or due to primary or secondary causes. Secondary or reactive thrombocytosis (RT) is far more prevalent than primary or clonal thrombocytosis. The presence of comorbid conditions in RT, a transient rise in platelets, and lack of genetic mutations favor a secondary etiology. Clinical manifestations of RT can range from no symptoms (most common) to acute thrombosis (rare), and elevated platelet counts may also be a predictor of underlying disease and of mortality. Recent studies of thrombocytosis in patients with COVID-19 infection have shown that elevated platelet counts are predictive of poorer prognosis. Therefore it is essential for an underwriter to identify RT, as RT is not always a benign entity, which means outcomes can vary. This article will focus on RT, which is the most common cause of thrombocytosis. It will contrast RT to primary thrombocytosis (PT), outline the factors that favor a diagnosis of RT vs. PT, discuss RT’s clinical manifestations and prognosis, and explore RT’s mortality risks and underwriting considerations, particularly in light of the current pandemic.

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Thrombocytosis, a condition defined as having a platelet count of more than 450,000 per microliter of blood (450x 109/L), can be either physiologic in nature or due to primary or secondary causes. Secondary or reactive thrombocytosis (RT) is far more prevalent than primary or clonal thrombocytosis. The presence of comorbid conditions in RT, a transient rise in platelets, and lack of genetic mutations favor a secondary etiology. Clinical manifestations of RT can range from no symptoms (most common) to acute thrombosis (rare), and elevated platelet counts may also be a predictor of underlying disease and of mortality. Recent studies of thrombocytosis in patients with COVID-19 infection have shown that elevated platelet counts are predictive of poorer prognosis. Therefore it is essential for an underwriter to identify RT, as RT is not always a benign entity, which means outcomes can vary. This article will focus on RT, which is the most common cause of thrombocytosis. It will contrast RT to primary thrombocytosis (PT), outline the factors that favor a diagnosis of RT vs. PT, discuss RT’s clinical manifestations and prognosis, and explore RT’s mortality risks and underwriting considerations, particularly in light of the current pandemic.

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