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May 2, 1936


JAMA. 1936;106(18):1588. doi:10.1001/jama.1936.02770180062027

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To the Editor:—  A case report on leukemia with thrombocytosis by Dr. Carl C. Drake (The Journal, March 21, p. 1005) omits two important points: first, the mechanism of bleeding in thrombocytosis and, second, the commonly occurring diseases with unusually high platelet counts.The paradoxical bleeding in the presence of unusually high platelet counts is due to vascular injury from embolic phenomena rather than to any diminution in the blood clotting function. This interpretation with a case citation of 1,300,000 platelets per cubic centimeter was given in my paper on the management of hemorrhagic problems in infancy and childhood (The Journal, Sept. 10, 1932, p. 895).Primary thrombocytosis, or thrombocythemia, was first described by Pianese in Haematologica (1:61, 1920), simultaneously by di Guglielmo (ibid., p. 303) and subsequently by other observers as indicated in Dr. Drake's report. Secondary thrombocytosis is prevalent in polycythemia, lymphogranulomatosis and chronic myelosis. Marked increase

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