title: Acroparesthesia and acral arterial occlusions as first manifestations of essential thrombocythemia.
abstract: Thrombocytosis is either caused by a reactive process (secondary thrombocytosis) or by a clonal bone marrow disorder The latter category includes essential thrombocythemia with bleedings and thrombotic complications as major causes of illness and death in this patients. We describe a 43-year-old man with a 6 months history of acroparesthesia in his toes. Half a year after onset of these symptoms, he noticed a bluish discoloration of digit V of his left foot. On first presentation physical examination revealed a bluish discoloration of all toes and a cold and blue digit V of the left foot. Peripheral pulses were all palpable, normal ankle systolic pressure measurements and normal pulse volume recordings except for digit V of the left foot were found. Laboratory tests revealed thrombocytosis of 800000/microliter. On treatment with acetylsalicylacid, prostanoids intravenously and low molecular weight heparin, the patient became asymptomatic and pulse volume recording of digit V was normalized. After exclusion of cardial or vascular sources of embolism by utrasonography bone marrow aspirate and biopsy supported the diagnosis of essential thrombocythemia.
authors.affiliation: Department of Internal Medicine, Divisions of Angiology, University Hospital Zurich, Switzerland. husmann@gmx.ch
authors.forename: M J
authors.initials: MJ
authors.lastname: Husmann
authors.forename: G Schenk
authors.initials: GS
authors.lastname: Romer
authors.forename: B R
authors.initials: BR
authors.lastname: Amann-Vesti
authors.forename: S
authors.initials: S
authors.lastname: Spada
authors.forename: R
authors.initials: R
authors.lastname: Koppensteiner
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology*; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology; D008297:Male; D010292:Paresthesia / Q000175:diagnosis / Q000209:etiology*; D013920:Thrombocythemia, Essential / Q000175:diagnosis*; D014034:Toes / Q000098:blood supply* / Q000294:innervation*