Diagnostic Utility of Platelet Indices in Differentiating Clonal and Reactive Thrombocytosis: A Comparative Cross-Sectional Study
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1309Abstract
Background: Thrombocytosis, defined as an elevated platelet count, can be broadly categorized into clonal and reactive types. Clonal thrombocytosis is associated with myeloproliferative neoplasms, whereas reactive thrombocytosis occurs secondary to inflammatory, infectious, or neoplastic conditions. Differentiating between these entities is clinically important, as management strategies and prognostic implications differ significantly. Platelet indices have emerged as accessible and cost-effective markers that may aid in this distinction.
Objective: To compare platelet indices—platelet count, mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW)—between clonal and reactive thrombocytosis.
Methodology: This comparative cross-sectional study was conducted at Saidu Medical College, Swat, and included 70 patients diagnosed with thrombocytosis (35 clonal and 35 reactive). Platelet indices were measured using an automated hematology analyzer. Statistical analysis was performed using R software version 4.3.1, and group comparisons were made using independent samples t-test. A p-value of <0.05 was considered statistically significant.
Results: The mean age and gender distribution were comparable between the two groups (p > 0.05). Platelet count was significantly higher in the clonal thrombocytosis group (771.54 ± 217.90 ×10⁹/L) compared to the reactive group (665.23 ± 162.48 ×10⁹/L) (p = 0.024). MPV and PCT were also significantly elevated in clonal thrombocytosis (p < 0.001). In contrast, PDW was significantly higher in reactive thrombocytosis (p < 0.001). Stratified analysis by gender demonstrated consistent findings across both subgroups.
Conclusion: Platelet indices, particularly MPV, PCT, and PDW, demonstrate significant differences between clonal and reactive thrombocytosis and may serve as practical, cost-effective tools for preliminary differentiation. However, confirmation with molecular and histopathological investigations remains essential.
Keywords: Clonal thrombocytosis, MPV, Platelet indices, PCT, PDW, Platelet count, Reactive thrombocytosis.
References
Chaudhary PK, Kim S. An insight into recent advances on platelet function in health and disease. Int J Mol Sci. 2022;23(11):6022. https://doi.org/10.3390/ijms23116022
Ghafoor MB, Sarwar F, Durrani TA, Azher ZQ, Jabeen S, Khan MHA. Pattern of thrombocytopenia in pregnancy at a teaching hospital of Rahim Yar Khan, Pakistan. J Rawalpindi Med Coll. 2022;26(4):688–692. https://doi.org/10.37939/jrmc.v26i4.2053
Gauer RL, Whitaker DJ. Thrombocytopenia: evaluation and management. Am Fam Physician. 2022;106(3):288–298. PMID: 36126009
Tremblay D, Yacoub A, Hoffman R. Overview of myeloproliferative neoplasms: history, pathogenesis, diagnostic criteria, and complications. Hematol Oncol Clin North Am. 2021;35(2):159–176. https://doi.org/10.1016/j.hoc.2020.12.001
Iurlo A, Bucelli C, Cattaneo D. Essential thrombocythemia in adolescents and young adults: clinical aspects, treatment options, and unmet medical needs. Curr Treat Options Oncol. 2023;24(7):802–820. https://doi.org/10.1007/s11864-023-01099-8
Stockklausner C, Duffert C, Cario H, Knöfler R, Streif W, Kulozik A, et al. Thrombocytosis in children and adolescents—classification, diagnostic approach, and clinical management. Ann Hematol. 2021;100:1647–1656. https://doi.org/10.1007/s00277-021-04500-0
Edahiro Y, Kurokawa Y, Morishita S, Yamamoto T, Araki M, Komatsu N. Causes of thrombocytosis: a single-center retrospective study of 1,202 patients. Intern Med. 2022;61(22):3323–3328. https://doi.org/10.2169/internalmedicine.9282-21
Han EY, Catherwood M, McMullin MF. Hereditary thrombocytosis: the genetic landscape. Br J Haematol. 2021;194(6):1098–1105. https://doi.org/10.1111/bjh.17741
Chiba N, Sugita A, Mizuochi M, Sato J, Saito T, Sakurai A, et al. Clinical significance of reactive thrombocytosis in the course of acute pancreatitis. BMC Gastroenterol. 2023;23(1):206. https://doi.org/10.1186/s12876-023-03047-5
Al-Tameemi WF, Noori AK. The impact of platelet indices in the evaluation of different causes of platelet count disorders. Iraqi J Hematol. 2022;11(1):32–37. https://doi.org/10.4103/ijh.ijh_47_21
Selvaraju V, Jayaganesh N. Platelet indices in differentiating reactive versus clonal thrombocytosis. Saudi J Pathol Microbiol. 2023;8(3):50–54. https://doi.org/10.36348/sjpm.2023.v08i03.002
Hafeez A, Naeem S, Robert HM, Mohsin S, Mahmood A. Platelet indices as a tool for differentiation between clonal thrombocytosis and reactive thrombocytosis. Pak Armed Forces Med J. 2023;73(Suppl-1):S79–S83. https://doi.org/10.51253/pafmj.v73iSUPPL-1.6350
Mohtashami M, Razavi A, Abolhassani H, Aghamohammadi A, Yazdani R. Primary immunodeficiency and thrombocytopenia. Int Rev Immunol. 2022;41(2):135–159. https://doi.org/10.1080/08830185.2021.1980160
Jaffer M, Shahid O, Aslam R, Saeed F, Arshad A, Hanif MT. Frequency of different causes of thrombocytosis among patients presenting to a tertiary care hospital. Prof Med J. 2024;31(4):581–587. https://doi.org/10.29309/TPMJ/2024.31.04.8129
Syed NN, Usman M, Khurshid M. Thrombocytosis: age-dependent aetiology and analysis of platelet indices for differential diagnosis. Indian J Pathol Microbiol. 2007;50(3):628–633.
Saeed BA, Taib SM, Nafih K. Platelet indices in the differential diagnosis of thrombocytosis. Ann Coll Med Mosul. 2009;35(1):31–33. https://doi.org/10.33899/mmed.2009.8895
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
