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- Page navigation anchor for Clinical relevance of thrombocytosis in primary careClinical relevance of thrombocytosis in primary carePlease forgive the lateness of my response to your excellent research article. I found it very thought-provoking and due to the apparent strength of the results, felt compelled to audit our practice population. Despite still being a work in progress, I have already identified a number of patients whom warrant further review.I must admit that I have struggled to reconcile the 1-year cancer incidence (11.6% for males, 6.2% for females) in the face of the oft-quoted 3% urgent referral threshold from NICE. Rightly or wrongly, I have concluded that said threshold refers to site-specific cancer risk e.g. lung, colorectal, breast etc., whereas yours is a composite risk for all cancers. A rudimentary analysis using the figures in the article gives the following 1-year incidence based on cancer site (top 3 quoted for each gender): lung (2.67%), colorectal (2.09%), prostate (1.62%) for males and colorectal (1.3%), lung (0.87%), breast (0.56%) for females. This puts the specific risks into perspective and also gives some guidance as to where we might focus our attention.Ostensibly then, patients with thrombocytosis do not automatically meet the 3% urgent referral threshold. However, I note that cancer risk was considerably greater when a second blood test showed thrombocytosis. It was also proportional to the patient’s age and the platelet count itself. Accordingly, there will be circumstances where the referral...Show MoreCompeting Interests: None declared.
- Page navigation anchor for Clinical relevance of thrombocytosis in primary careClinical relevance of thrombocytosis in primary careThank you for your eLetter, which discusses the one year cancer incidence of 4.1% in males over 40 with a normal platelet count. We were surprised at this too.You raise an interesting point and one which we are currently investigating. The 4.1% risk found in the males with a normal platelet count in the present cohort probably reflects the increased likelihood of something being wrong with a patient who has a blood test, regardless of the test result. Investigation for malignancy would not be recommended based on the findings in this study: in effect, all men with a full blood count would be considered for cancer. Rather, we expect the GP would investigate on the symptoms or signs which prompted the blood test – this would also focus any investigation.It is likely the higher risk for cancer are clustered at the high end of the normal platelet count; we have recently been awarded funding to investigate this possibility in a fresh cohort of patients.Competing Interests: None declared.
- Page navigation anchor for Clinical relevance of thrombocytosis in primary careClinical relevance of thrombocytosis in primary care
One thing jumped out at me from this paper which the authors didn't comment on. The risk of developing cancer within one year in a male >40 years with a platelet count of less than 400, is 4.1% which is above the cut-off at which NICE suggest investigating for malignancy. What does this mean for GPs? That if we consider taking a full blood count in an older male (for any reason) we should really be asking ourselves, could this be cancer?
Competing Interests: None declared.