Differential Diagnosis for 65 yo with HA and Thrombocytosis

• Single most likely diagnosis:
  • Essential Thrombocythemia: This is a myeloproliferative disorder that can cause elevated platelet counts, and the patient's recent splenectomy could be a contributing factor. The patient's age and lack of other symptoms also make this a plausible diagnosis.
• Other Likely diagnoses:
  • Reactive Thrombocytosis: This is a common cause of elevated platelet counts, often seen in response to surgery, infection, or inflammation. The patient's recent surgery and possible underlying infection or inflammation could be contributing to the thrombocytosis.
  • Hypertension-related complications: The patient's high blood pressure (SBP 180s) could be causing headaches, and it's essential to consider the potential consequences of uncontrolled hypertension, such as stroke or cardiovascular disease.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Cerebral Venous Thrombosis (CVT): Although the CT head is negative, CVT can be a cause of headache and thrombocytosis, and it's crucial to consider this diagnosis due to its high mortality rate if left untreated.
  • Thrombotic Thrombocytopenic Purpura (TTP): Although the platelet count is elevated, TTP can present with a wide range of platelet counts, and it's essential to consider this diagnosis due to its high mortality rate if left untreated.
• Rare diagnoses:
  • Myeloproliferative Neoplasm (MPN) associated with neuroendocrine tumor: Although rare, some neuroendocrine tumors can be associated with MPNs, which could explain the patient's thrombocytosis.
  • Paraneoplastic syndrome: The patient's history of neuroendocrine tumor could be related to a paraneoplastic syndrome, which can cause a variety of symptoms, including thrombocytosis and headaches.