A 68-year-old female saw her primary care physician for a routine physical. Her only complaint at the time was fatigue and frequent insomnia. Besides a corticosteroid inhaler for mild asthma and a daily vitamin, she took no other meds. A routine CBC and chemistry panel were ordered on the patient. Her chemistry results were all within the normal range. Her CBC showed the following results:
| Patient Results | Reference Range |
| Hemoglobin (g/dL) | 13.1 | 12–15 |
| WBC (x 109 /L) | 7.2 | 4.5–11.5 |
| Platelets (x 109 /L) | 620 | 150–450 |
All other CBC results were within reference ranges.
Of note is a substantially elevated platelet count. The physician questioned the patient whether she had any other symptoms besides insomnia and fatigue. She admitted to having lost about 10 pounds without really trying. A repeat platelet count was ordered to be drawn in three weeks, along with a panel of inflammatory markers (such as acute phase reactants) and an iron panel.
