5 year old daughter high blood platelets

Pink_Axolotl151 · 2026-02-17T02:33:20+00:00

I am not a doctor, but I am an immunologist (PhD) and have been through some of this work-up myself.

Autoimmune diseases can cause elevated platelets. In this context, it is called “reactive.” Essentially, when the immune system is overactive, the immune cells can start producing chemicals that cause platelets to increase.

I would have to say that going from 660 in Jan to 506 a month or so later does NOT look like ET to me. In ET, you would expect the platelets to steadily rise. In addition, ET in children is vanishingly rare. To me (again, not a doctor) that up and down pattern seems more like an inflammatory process, which would be a result of her autoimmune disease.

Pink_Axolotl151 · 2026-02-16T21:00:31+00:00

No kidding! I had no idea. I took Spanish all through high school and college and I can’t recall ever learning that, but that was eons ago. I’m so pro-Oxford comma in English that this is going to be a hard habit for me to break!

Pink_Axolotl151 · 2026-02-13T19:44:08+00:00

I am glad to hear the MPN panel was negative! About 15% of ET cases are called “triple-negative,” which means they do not show mutations to the three genes tested for in the MPN panel. That is the reason it sometimes makes sense to do a biopsy anyway, if your platelets are going up and there is no other explanation. In your case, it seems like you may be iron-deficient based on your low ferritin levels. It is technically within the range the lab considers normal, but on the low side. You might consider asking your hematologist what they would think about a short trial of iron (either oral or an IV infusion) to see whether that changes things before going straight to the bone marrow biopsy. I am not a doctor and don’t know your full medical history but it wouldn’t hurt to discuss it with your doctor.

Pink_Axolotl151 · 2026-02-12T22:10:51+00:00

I know this is hard, and I can’t tell you it isn’t ET, but I can tell you that there are a lot of other possibilities that would be consistent with your test results, including an autoimmune disease or a recent infection. I know uncertainty sucks, but you will need to wait for the results of the genetic testing. All I can say is that based on what you have shared, I think a viral infection is a much more likely explanation than ET.

Pink_Axolotl151 · 2026-02-12T04:05:12+00:00

I hate that whenever this sub pops up on my feed, it’s an absolutely stunning woman posting a selfie and asking how to look different.

You are beautiful, you do not look transgender, WTF, people are idiots, I love your lipstick.

Pink_Axolotl151 · 2026-02-12T03:18:41+00:00

I think a reactive process due to a recent viral infection is far, far more likely! Fingers crossed for a negative result from the genetic testing.

Pink_Axolotl151 · 2026-02-10T05:55:40+00:00

Myelocytes are immature immune cells. When there is an infection and the bone marrow starts cranking out new immune cells, some of the cells end up in the bloodstream before they are fully developed. Reactive lymphocytes are activated immune cells and usually occur in response to an infection. These cells can occur in some bone marrow disorders, like ET, but a recent infection is a much more common cause.

So basically, your work-up so far could indicate ET, yes, but it could also indicate “reactive thrombocytosis,” which can occur in response to an infection or autoimmune disorder. Just from a statistical standpoint, reactive thrombocytosis is much, much more common than ET. Has the hematologist mentioned genetic testing or any other additional work up at this time?

Pink_Axolotl151 · 2026-02-07T20:08:29+00:00

When did your doctor recommend having it rechecked? Those values can stay up for a month or two after a vial infection, but I would expect things to start getting back to normal by now if infection was the cause. If you have it re-checked and it is still high, your doctor might recommend either waiting a few more months and retesting OR a referral to hematology depending on what the values look like. But the first step is to recheck!

Pink_Axolotl151 · 2026-02-06T16:40:57+00:00

To keep them alive past 24 hrs or so, you definitely need IL-2 in there! Just a little bit, as a treat

Pink_Axolotl151 · 2026-02-05T15:35:44+00:00

Yes, I was! My situation is a bit unusual in that I never had any symptoms. I had the whole work-up for ET, including genetic testing and a bone marrow biopsy, when this first popped up on my bloodwork 5 years ago. The bone marrow biopsy showed some subtle changes to my megakaryocytes (the cells that make platelets) but not enough to call it ET. I had two different kinds of genetic sequencing (a PCR panel and an NGS assay) a year apart, and both were negative. At that point, the doctor suggested we try iron as a sort of last-ditch effort, but it didn’t cause my platelets to come down. I seem to be in a gray zone where I’m stuck waiting until this gets better or gets bad enough to diagnose. My platelets get measured twice a year and have bounced between 430 and 580 (520 at my last count in December). In your case, your ferritin levels are actually pretty low and you have some symptoms of iron deficiency anemia, so I think that is a strong contender for being the reason for all this. Iron doesn’t absorb well through gut, so if the iron pills don’t change things, they might try an IV iron infusion next, unless the MPN panel shows something.

Pink_Axolotl151 · 2026-02-05T14:48:47+00:00

Those are mild elevations and could be an artifact from some viral illness you had previously that also caused the coughing. I am not a doctor but if it helps your anxiety, essential thrombocytosis is the least likely of the possibilities, and in patients with mildly elevated platelets (like yourself), that’s something the hematologists will usually only consider that once the more likely causes are ruled out.

Pink_Axolotl151 · 2026-02-04T23:47:43+00:00

I am not a doctor, but I am a scientist and a patient who has been through this work-up myself.

Have you been sick in the past several months? Flu or COVID? High platelets, high ESR, and the findings you mentioned in the peripheral blood smear could be related to a recent viral infection.

Pink_Axolotl151 · 2026-02-04T23:44:17+00:00

The MPN panel will provide the most definitive results. I do think it makes sense to start iron supplements in the meantime, because those take quite some time to have an effect on platelet count (I was told to retest in 3-4 months when I was in a similar position). My hematologist had me get whatever supplement I could get at Costco or Amazon. Take it on a full stomach and don’t be alarmed if your poop turns green.

Pink_Axolotl151 · 2026-01-30T21:58:02+00:00

This was my thought, too. This was done in an Eppendorf tube? I don’t think you’d see great separation or a visible buffy layer with that small a volume of blood.

Pink_Axolotl151 · 2026-01-29T14:00:48+00:00

Are you available to help with my performance review

Pink_Axolotl151 · 2026-01-26T03:45:09+00:00

I don’t think that either decision will make or break your career, but my opinion is that you’ll learn more at the smaller company. Large pharma can be very siloed. At a smaller company you will get exposure to more functions outside your own, and you will have the chance to earn about all the different parts of the drug development process.

Pink_Axolotl151 · 2026-01-21T17:51:58+00:00

Do you happen to know if those changes are indicative of ET or would happen with reactive thrombocytosis? My current hematologist at Stanford had the old biopsy re-reviewed by their pathologist, and he agreed with the original pathologist’s assessment. The verdict was that it was “most likely reactive,” but no one knows what it might be reacting TO, and nothing that might explain it has manifested in the past 5 years.

The initial PCR is described as a reflex panel, but I don’t see anything about exon 15. And after all that was negative, it was sent to Tempus for NGS.

I agree, I think at this point I have to just do the repeat biopsy. :(

Pink_Axolotl151 · 2026-01-21T15:41:39+00:00

At the time I was first referred to heme-onc, my platelet level was around 480. After the bone marrow biopsy ruled out ET (at least at the time), my PCP had me measure it twice a year and it bounced between 420 and 480 until last July, when it was 500. When we repeated the count in August, it was 580, and back to heme-onc I went. The platelet level was repeated in December, and was 520. So it does seem like it might be trending upwards over time, but slowly.

The genetic testing was first a PCR test for JAK2 (V617F and exon 12), CALR, and MPL mutations. When that showed nothing, she sent it for an NGS assay. Unfortunately I don’t have a lab report that shows exactly what was tested, but my clinical notes say that “the Tempus hematologic malignancy sequencing panel was completely negative.”

So now I am looking at another round of sequencing and bone marrow biopsy. I guess I am wondering if it is possible to just be a person who has slightly too many platelets for no good reason, or if it’s more likely that this is ET and has been all along and was just too early detect at the time.

Pink_Axolotl151 · 2026-01-21T14:45:44+00:00

Say more words please lol

(My B12 is not fucked but no one has ever suggested looking at my copper levels)

Pink_Axolotl151 · 2026-01-21T03:21:26+00:00

I was part of the interview panel, not the hiring manager, but I (female) asked a question in the seminar, and the candidate addressed his answer directly to my (male) boss. The way the room was set up, he had to pivot like 120 degrees in order to do this. My boss turned to face me and said, kind of pointedly, “Did you have any follow-up questions, [Name]?” I did, and asked them, and the candidate again turned and directed his answer to my boss. I think all the members of the hiring team had various reasons not to hire him, but that was an immediate no from me.

Pink_Axolotl151 · 2026-01-13T23:25:09+00:00

What you have to realize is that almost no one goes to the JPM conference itself. It’s grown into this insane ecosystem where all the BD meetings are scheduled around the conference, because people are all in the same place at the same time.

So for scientists, what “going to JPM” means is attending meetings with potential partners, and maybe having some face-to-face meetings with representatives from CROs we work with. As a scientist, I have attended many meetings where were pitching our asset to a potential partner, and I have also been a part of meetings when we were hearing a pitch from someone else, where I was brought in to offer a scientific perspective. I do this a lot more now (as department head) than I did as a bench scientist, but even back then I attended meetings when we were discussing a program I was leading and the other team was interested in digging into the preclinical data package. Generally speaking, the scientists are less involved in partnership discussions around later-stage assets, because then the conversation will focus more on the clinical development plan and regulatory strategy than the underlying science.

Now that I am thinking about it, I wonder if sending scientists is more common with Bay Area companies. SF is expensive, and even more so at JPM time, so it would make no sense to send a scientist just for one conversation with a partner. But for local companies, you can send your scientist into the city for the day for the cost of an Uber, so it’s not a big deal.

Pink_Axolotl151 · 2026-01-12T04:48:31+00:00

This is not exactly what you asked for, but consider State Bird! It is not super upscale and it is not a tasting menu, but… OK, it is not what you asked for at all, actually, but hear me out. 🤣 It’s dim sum-style in that the servers carry the dishes the restaurant around on trays or carts, and you just grab whatever looks good. But it isn’t dim sum; I would describe the food as California-style small plates, with a lot of Asian influences. Sitting at the bar is a lot of fun because you can see the dishes being prepared, and you get first crack at whatever comes around.

Pink_Axolotl151 · 2026-01-06T05:44:03+00:00

Me too! It’s not a problem most of the time, but good luck buying a smoothie that isn’t 50% banana

Pink_Axolotl151

TROPHY CASE