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Trombocitose : estudo etiológico numa população hospitalar
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Abstract(s)
Introdução: Trombocitose é definida como uma contagem plaquetar acima do limite superior do normal. Constitui um achado laboratorial incidental frequente, com um amplo e desafiante diagnóstico diferencial. Pode ser classificada em dois tipos principais: trombocitose primária e trombocitose secundária. A avaliação etiológica desta alteração laboratorial é relevante pelas suas implicações na ponderação primária destes doentes, para uma melhor e atempada investigação, tratamento e prognóstico.
Objetivos: Descrever as principais etiologias de trombocitose no cenário de uma enfermaria de Medicina Interna e avaliar a utilidade de determinados parâmetros laboratoriais na distinção entre as trombocitoses primária e secundária.
População e métodos: Estudo retrospetivo de um ano que incluiu doentes com, pelo menos, uma contagem plaquetar superior a 450,000 /μL, internados num serviço de Medicina Interna de um hospital universitário.
Resultados: Trombocitose foi associada a um processo secundário em 333 doentes (96.24%) e primário em 13 doentes (3.56%). Trombocitose primária verificou-se, significativamente, com maior frequência no sexo masculino e as etiologias de infeção, doença inflamatória e trombocitose rebound foram mais frequentes no sexo feminino. A Policitémia Vera foi a causa mais frequente de trombocitose primária e a infeção a causa mais frequente de trombocitose secundária. Entre estes dois grupos encontrou-se, para alguns parâmetros hematológicos rotineiros, uma diferença estatisticamente significativa. Verificou-se que o tempo até à normalização completa da trombocitose e que a taxa de complicações tromboembólicas era significativamente superior na trombocitose primária.
Conclusões: O reconhecimento das principais etiologias de trombocitose e das principais diferenças entre vários marcadores laboratoriais pode auxiliar na abordagem diagnóstica da trombocitose.
Background: Thrombocytosis is defined as a platelet count above the upper limit of normal. It constitutes a recurring incidental laboratory finding, with a vast and challenging differential diagnosis. It can be classified in two main groups: primary thrombocytosis and secondary thrombocytosis. Its etiologic evaluation proves to be relevant due to its implications in the primary evaluation of these patients, for a better and timely investigation, treatment and prognosis. Objectives: To describe the main etiologies of thrombocytosis in the setting of an Internal Medicine ward and to evaluate the utility of multiple laboratory parameters in the distinction of primary and secondary thrombocytosis. Population and Methods: Retrospective study of one year that included patients with, at least, one platelet count above 450,000 /μL, hospitalized in an Internal Medicine ward of a university hospital. Results: Thrombocytosis resulted from a secondary process in 333 patients (96.24%) and from a primary process in 13 patients (3.56%). Primary thrombocytosis was significantly more frequent in males and infection, inflammatory disease and rebound thrombocytosis was more frequent in females. Polycythemia vera was the most common cause of primary thrombocytosis and infection was the most common cause of secondary thrombocytosis. Between the two groups, a statistically significant difference was found in multiple hematological parameters. The time to normalization of the platelet count and the rate of thromboembolic complications was significantly higher in primary thrombocytosis. Conclusion: The recognition of the main etiologies of thrombocytosis and the main differences in multiple laboratory parameters might assist in the diagnostic approach of thrombocytosis.
Background: Thrombocytosis is defined as a platelet count above the upper limit of normal. It constitutes a recurring incidental laboratory finding, with a vast and challenging differential diagnosis. It can be classified in two main groups: primary thrombocytosis and secondary thrombocytosis. Its etiologic evaluation proves to be relevant due to its implications in the primary evaluation of these patients, for a better and timely investigation, treatment and prognosis. Objectives: To describe the main etiologies of thrombocytosis in the setting of an Internal Medicine ward and to evaluate the utility of multiple laboratory parameters in the distinction of primary and secondary thrombocytosis. Population and Methods: Retrospective study of one year that included patients with, at least, one platelet count above 450,000 /μL, hospitalized in an Internal Medicine ward of a university hospital. Results: Thrombocytosis resulted from a secondary process in 333 patients (96.24%) and from a primary process in 13 patients (3.56%). Primary thrombocytosis was significantly more frequent in males and infection, inflammatory disease and rebound thrombocytosis was more frequent in females. Polycythemia vera was the most common cause of primary thrombocytosis and infection was the most common cause of secondary thrombocytosis. Between the two groups, a statistically significant difference was found in multiple hematological parameters. The time to normalization of the platelet count and the rate of thromboembolic complications was significantly higher in primary thrombocytosis. Conclusion: The recognition of the main etiologies of thrombocytosis and the main differences in multiple laboratory parameters might assist in the diagnostic approach of thrombocytosis.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Keywords
Trombocitose primária Trombocitose secundária Score Duração da trombocitose Complicações tromboembólicas