From the Research
The management of a patient with elevated platelet count and increased red cell distribution width requires a systematic approach focusing on identifying and treating the underlying cause, with a recent study suggesting that elevated RDW and platelet distribution width are associated with autoimmune liver diseases 1. The diagnostic workup should include a complete blood count with peripheral smear to confirm the findings and assess for other abnormalities.
- Inflammatory markers (ESR, CRP) should be checked to evaluate for inflammation, as elevated RDW and platelet distribution width have been correlated with increased CRP levels 1.
- Iron studies, vitamin B12 and folate levels, and JAK2 mutation testing should be considered if myeloproliferative disorders are suspected.
- For reactive thrombocytosis due to inflammation or infection, treating the underlying condition is the primary approach.
- If essential thrombocythemia is diagnosed, cytoreductive therapy with hydroxyurea (starting at 15-20 mg/kg/day) is typically recommended for high-risk patients, along with low-dose aspirin (81-100 mg daily) to prevent thrombotic events.
- For patients with iron deficiency causing elevated RDW, oral iron supplementation (ferrous sulfate 325 mg three times daily) for 3-6 months is indicated, as reticulocyte hemoglobin content has been shown to be a useful marker for diagnosing iron deficiency and monitoring iron therapy 2. Regular monitoring of complete blood counts every 1-3 months is essential to assess treatment response, as the elevated RDW often indicates significant red cell size variation, which may result from nutritional deficiencies, hemoglobinopathies, or bone marrow disorders, while thrombocytosis can increase thrombotic risk, making prompt diagnosis and treatment crucial for preventing complications 3.