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Fatemah Al Wusibai Presented Triple-Negative Thrombocytosis on BSH 2025
Fatemah Al Wusibai/LinkedIn
Dec 21, 2025, 11:23

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.

Fatemah Al Wusibai Presented Triple-Negative Thrombocytosis on BSH 2025

 

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

  1. Exclude secondary causes
  2. Test JAK2 / CALR / MPL ± BCR::ABL1
  3. 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”

Fatemah Al Wusibai Presented Triple-Negative Thrombocytosis on BSH 2025

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(inflammation Atypical megakaryocytes BSH 2025 drugs essential thrombocythaemia (ET) Fatemah Al wusibai Health Hemostasis Hemostasis Today Idiopathic thrombocytosis Infection Iron-Deficiency JAK2 malignancy Medicine Obesity Thrombocytosis thrombosis
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