Fatemah Al Wusibai Presented Triple-Negative Thrombocytosis on BSH 2025
Fatemah Al Wusibai, Senior Registrar medicine at Prince Sultan Military Medical City, shared a post on LinkedIn:
“Triple-Negative Thrombocytosis | BSH 2025
What does “triple-negative” mean?
Persistent thrombocytosis without JAK2, CALR or MPL mutations.
Step 1: Start with the basics
>80% of thrombocytosis is reactive
(iron deficiency, infection, inflammation, malignancy, drugs, obesity)
Treat the underlying cause
Antiplatelet therapy is not routinely indicated
Step 2: When is it clonal?
Triple-negative essential thrombocythaemia (ET) accounts for ~10–15%
Typical features:
• Younger patients, often female
• Lower thrombotic risk
• Excellent long-term prognosis
Step 3: Investigation strategy (BSH)
Persistent platelets >450 ×10⁹/L
- Exclude secondary causes
- Test JAK2 / CALR / MPL ± BCR::ABL1
- Bone marrow biopsy + myeloid NGS only if:
• Age >60 years
• Prior thrombotic/vascular event
• Platelets >1500 ×10⁹/L
• Significant symptoms or cardiovascular risk factors
Not every patient requires bone marrow biopsy
Step 4: New diagnostic terminology (key update)
To avoid over-diagnosis and over-treatment, BSH proposes:
• ITUS – Idiopathic thrombocytosis, no mutation, no atypia
• ITAM – Atypical megakaryocytes, no clonal marker
• CTUS – Clonal mutation (non-MPN driver) without ET morphology
Goal: more precise diagnosis and individualized care
Step 5: Management principles
- Observation alone for most patients
- Aspirin only if cardiovascular risk factors or significant symptoms
- Cytoreduction (preferably interferon-α) reserved for:
• Thrombotic/haemorrhagic events
• Extreme thrombocytosis
• Refractory symptoms”
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