Differential Diagnosis for Elevated Platelets with Normal Iron

• Single most likely diagnosis
  • Reactive thrombocytosis: This condition is characterized by an elevated platelet count in response to a non-neoplastic stimulus, such as inflammation, infection, or trauma. The normal iron level supports this diagnosis, as iron deficiency can also cause thrombocytosis.
• Other Likely diagnoses
  • Myeloproliferative neoplasms (MPN): Although less likely than reactive thrombocytosis, MPNs such as essential thrombocythemia can cause elevated platelet counts. Normal iron levels do not rule out MPN, but further testing (e.g., JAK2 mutation) would be necessary for diagnosis.
  • Chronic inflammation: Ongoing inflammation can stimulate platelet production, leading to elevated counts. Conditions like rheumatoid arthritis or chronic infections could be underlying causes.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Polycythemia vera: A type of MPN that can present with elevated platelets, even with normal iron levels. Missing this diagnosis could lead to severe complications, including thrombosis and transformation to acute myeloid leukemia.
  • Cancer: Certain types of cancer, such as lung, gastrointestinal, or ovarian cancer, can cause paraneoplastic syndromes, including thrombocytosis. Although less common, it is crucial to consider malignancy as a potential underlying cause.
• Rare diagnoses
  • Familial thrombocytosis: A rare genetic disorder characterized by isolated thrombocytosis. This diagnosis would require further genetic testing and family history evaluation.
  • Thrombopoietin (TPO) receptor mutations: Mutations in the TPO receptor can lead to congenital thrombocytosis. This diagnosis is rare and would require specific genetic testing.