SHM Converge Scientific Abstract ePoster Gallery-Extreme Thrombocytosis in Chronic Myelogenous Leukemia

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This case report describes a 31-year-old woman with chronic myeloid leukemia (CML) who presented with severe post-prandial abdominal pain and night sweats, but only mild leukocytosis and extraordinarily high platelet counts of 2.5 million. Extreme thrombocytosis prompted urgent inpatient evaluation because of the risk of serious complications. Bone marrow biopsy showed micromegakaryocytes, and testing confirmed the BCR-ABL fusion gene, establishing the diagnosis of CML.<br /><br />A notable complication occurred during hospitalization: prolonged bleeding from the biopsy site, attributed to acquired von Willebrand deficiency caused by the extreme platelet elevation. This illustrates an important but sometimes overlooked danger of marked thrombocytosis—bleeding risk, not just thrombosis. After the bleeding resolved, the patient was started on dasatinib, and her blood counts improved rapidly. Her abdominal pain also resolved as the platelet count decreased, suggesting a possible microvascular ischemic mechanism.<br /><br />The report emphasizes that CML usually presents with marked leukocytosis, but in rare cases can present primarily with extreme thrombocytosis and minimal leukocytosis. It also highlights that abdominal pain as the sole or dominant presenting symptom is unusual and may represent a novel manifestation of CML. The case underscores the need for hospitalists and other clinicians to recognize CML as a cause of extreme thrombocytosis, to consult hematology promptly, and to begin appropriate treatment early to prevent potentially serious bleeding and other complications.

Asset Subtitle

William H. Colthorpe

Meta Tag

Author List Charles Jacocks, Wilfred Delacruz, William H. Colthorpe

Category Clinical Vignettes

Concept Chronic Myeloid Leukemia

Concept Thrombocytosis

Concept BCRABL1 Fusion

Concept Acquired von Willebrand Syndrome

Concept Tyrosine Kinase Inhibitor

Distinguished Non-Finalist

Presenter Organization Usaf

Presenting Author William H. Colthorpe

Track Adult

Keywords

chronic myeloid leukemia

CML

extreme thrombocytosis

BCR-ABL fusion gene

micromegakaryocytes

acquired von Willebrand deficiency

bleeding risk

abdominal pain

dasatinib

platelet count

Chronic Myeloid Leukemia

Thrombocytosis

BCRABL1 Fusion

Acquired von Willebrand Syndrome

Tyrosine Kinase Inhibitor