Kavya Keerthana: The Platelet Count Everyone Calls ‘Reactive’ Until It Isn’t
Kavya Keerthana, Hematologist at Prime Health, shared a post on LinkedIn:
“Mild Thrombocytosis: The Platelet Count Everyone Calls ‘Reactive’ Until It Isn’t
A patient comes in for something unrelated.
The CBC shows platelets at 520. Someone writes ‘reactive, recheck in follow-up’ – and nobody ever does.
Mild thrombocytosis is not one entity.
It’s a spectrum – from a transient bump after infection or iron deficiency, to an early myeloproliferative process quietly raising thrombotic risk long before a diagnosis is made.
The decision point isn’t the number. It’s recognizing when ‘probably reactive’ stops being a safe assumption.
A practical escalation pathway for persistent mild thrombocytosis:
- Separate transient reactive triggers (infection, iron deficiency, post-splenectomy, post-op) from a pattern with no clear driver
- Know which findings should prompt molecular testing rather than a repeat CBC
- Understand when JAK2 V617F, CALR, and MPL testing is indicated — and when it isn’t yet
- Recognize that thrombosis risk can precede a confirmed clonal diagnosis, and should be assessed independently
Hard decision points:
- Single, explained rise (post-op, infection, iron deficiency) – recheck in 4–6 weeks. One value should never trigger molecular workup.
- Platelets more than 450 x 10⁹/L, persistent beyond 3 months, no reactive cause found – send MPN panel, examine for splenomegaly, check for iron deficiency as a masking factor.
- Any thrombocytosis with a prior thrombotic event, microvascular symptoms (erythromelalgia, visual disturbance, digital ischemia), or counts more than1000 x 10⁹/L – don’t wait for molecular results. Risk-stratify for cytoreduction and antiplatelet therapy now.
The number that gets flagged as an incidental finding is sometimes the first sign of something that needed action months earlier.”
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