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”
Never miss hematology updates on Hemostasis Today.
-
Apr 15, 2026, 04:52Ulrich Pecks: Personalized Approaches to VTE Prevention in Pregnant Women with Inherited Thrombophilia
-
Apr 15, 2026, 04:06Brenda Pleasant: Insights from the HFA Symposium on Hemophilia Care
-
Apr 15, 2026, 03:43Lexy Halloran: Addressing Diagnostic Inequities in Women with Chronic Conditions
-
Apr 14, 2026, 17:32Denise M.: Surviving Sepsis 2026 – The Upstream Revolution
-
Apr 14, 2026, 17:23Meghanath Yenni։ What’s New in Acute Ischemic Stroke in 2026
-
Apr 14, 2026, 17:11Phil Spinella: What Dose of TXA for Children With Severe Traumatic Bleeding Should You Use?
-
Apr 14, 2026, 17:08Abdulrahman Katib: How Endovascular Stenting Is Transforming the Treatment of Severe PTS
-
Apr 14, 2026, 17:00Anna A. Avagyan: Glad to Be Part of EHA Pediatric Hematology-Oncology Course
-
Apr 14, 2026, 16:58Ney Carter Borges: NLRP3 Inhibition in Atherosclerosis – Early Clinical Signal Beyond Lipids