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Case Reports
. 2024 Jun;22(2):112-114.
doi: 10.3121/cmr.2024.1899.

Extreme Reactive Thrombocytosis Caused by Obstructive Nephrolithiasis and Pyelonephritis

Jeffrey Zhong  1 , Clifford D Packer  2
Affiliations
Case Reports

Extreme Reactive Thrombocytosis Caused by Obstructive Nephrolithiasis and Pyelonephritis

Jeffrey Zhong et al. Clin Med Res. 2024 Jun.

Abstract

Platelet counts in reactive thrombocytosis rarely exceed 1000 × 109/L. We present the case of a male patient, aged 80 years, with quiescent rheumatoid arthritis who was found to have a platelet count of 1011 × 109/L on routine laboratory testing. The patient was initially asymptomatic but developed leukocytosis to 23.1 × 109/L on hospital day 2. Diagnostic work-up revealed obstructive nephrolithiasis and pyelonephritis, and the thrombocytosis and leukocytosis gradually resolved with empiric antibiotic treatment and ureteral stent placement. Tests for myeloproliferative disorders, including JAK-2V617F mutation, BCR-ABL for chronic myeloid leukemia and acute lymphocytic leukemia, and myeloproliferative neoplasms (MPL/CALR), were negative. Physicians should be aware that in rare cases reactive thrombocytosis can exceed 1000 × 109/L, and that markedly elevated platelet counts in the setting of urinary tract infections may be an early sign of obstructive uropathy.

Keywords: Geriatrics; Hematology; Obstructive uropathy; Reactive thrombocytosis; Urinary tract infection.

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Figures

Figure 1.
Figure 1.
Clinical course in a man, aged 80 years, with reactive thrombocytosis caused by obstructive nephropathy and pyelonephritis.
See this image and copyright information in PMC

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