Reactive thrombocytosis seldom produces any symptoms. In cases, when individuals suffering from the condition present with symptoms, they primarily occur due to the underlying disease. Individuals with reactive thrombocytosis, experience chest pain, undue fatigue, weakness, dizziness accompanied by fainting. In addition, they can also experience changes in vision and development of numbness in hands and feet [8].

• Inflammation

  If iron deficiency or inflammation is present, no further tests are warranted. [cancertherapyadvisor.com]

  Secondary thrombocytosis can be traced to another cause, such as inflammation, severe bleeding, iron deficiency, or some cancers. Primary thrombocytosis (or essential thrombocythemia) is a single disease entity, with unique clinical characteristics. [medical-dictionary.thefreedictionary.com]

  In patients with PHA1, miliaria rubra-like cutaneous eruptions are suggested to occur due to obstruction of eccrine sweat glands through inflammation caused by excessive sodium excretion in sweat during hyponatremic crises. [ncbi.nlm.nih.gov]

  Arthritis Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. [digitalnaturopath.com]

• Splenectomy

  Her post splenectomy platelet count was 227 × 10(6)/ml which elevated to 1623 × 10(6)/ml on the 7th postoperative day. A single thrombocytapheresis procedure reduced her platelet to 403 × 10(6)/ml. [ncbi.nlm.nih.gov]

• Asymptomatic

  Nonetheless, treatment of asymptomatic reactive thrombocytosis is generally not recommended.1,4 Management of myeloproliferative/clonal thrombocytosis in the ED Asymptomatic patients may need treatment to prevent thrombotic complications. [emdocs.net]

  Autonomous thrombocytosis Asymptomatic 81mg ASA PO daily. If high risk for thrombotic event (>60 yrs, history of thrombosis, or known JAK2 mutation), consider 15mg/kg hydroxyurea PO daily. Consult if available. [wikem.org]

  Treatment of asymptomatic JAK2V617F positive ET and target platelet count on cytoreduction were significantly influenced by physician years of experience. [ncbi.nlm.nih.gov]

  Many ET patients are asymptomatic. Consequently, the disease is often diagnosed as part of a routine check-up, after a blood test reveals a high platelet count. [mpnresearchfoundation.org]

  Therefore, asymptomatic patients with thrombocytosis must have a comprehensive physical evaluation for malignancy or other potentially treatable disease. B. [asams.org]

• Fever

  The second patient was a 7-year-old boy who presented with fever, cough and cold of 2-week duration. Examination revealed mild hepatomegaly with palpable spleen tip. [ncbi.nlm.nih.gov]

  I am currently in my early 30s and symptoms like fever, headaches, dizziness and sweating for more than a week triggered me to seek medical attention as it is not a normal fever that I used to experience. [lifewithet.wordpress.com]

  To the Editor: Fever of unknown origin (FUO) associated with anemia and thrombocytosis may represent a diagnostic challenge for the hematologist. [annsaudimed.net]

  Patients should be questioned carefully for : - systemic and specific symptoms which might suggest infection or neoplasm, for example, fever, weight loss, night sweats, cough, hemoptysis, melena or hematuria - symptoms of bleeding and / or ischemia (for [tcd.ie]

• Surgical Procedure

  It has also been advised that, individuals who are on blood thinning medications should tell the same to their doctor before undergoing any surgical procedures. [symptoma.com]

  RESULTS: For 6 years, there were 2498 major gynecologic oncology surgical procedures performed at our institution. Within 14 days of surgery, 107 CT-PA studies were obtained with a positive study rate of 24.3%. [ncbi.nlm.nih.gov]

  procedures or tooth removal Most of the time, ET is found through blood tests done for other health problems before symptoms appear. [nlm.nih.gov]

  Write down your health history, including recent infections, surgical procedures, bleeding and anemia. Write down key personal information, including any major stresses or recent life changes. [nchmd.org]

• Aspiration

  Examination of the bone marrow aspirate revealed normal cellularity and normal myeloid: erythroid ratio with marked megakaryocytic hyperplasia. [ncbi.nlm.nih.gov]

  Feulgen -stained bone marrow aspirates from 11 patients with reactive thrombocytosis and 12 patients with clonal thrombocytosis of chronic myeloproliferative disorders (CMPDs) were analysed. [worldcat.org]

  Peripheral blood smear, ferritin, serum iron, serum total iron binding capacity (TIBC), bone marrow biopsy with aspirate and cytogenetic testing, JAK2 serum and/or aspirate testing. [clinicaladvisor.com]

  In addition, blood smear test and bone marrow aspiration are also indicated. Treatment: Treatment of thrombocytosis involves correcting the underlying disease condition which would gradually bring back the level of platelet count to normal again. [symptoma.com]

• Pneumonia

  The mean thrombocyte counts in the patients who had been diagnosed as pneumonia and as bronchiolitis were found significantly higher than control group (p Likewise, the number of patiens who have thrombocytosis with pneumonia and bronchiolitis were significantly [omicsonline.org]

  A 47-year-old woman with marked thrombocytosis of 1,650 × 10(9)/L was diagnosed with chronic eosinophilic pneumonia (CEP) based on imaging of the lung and abundant eosinophils in bronchoalveolar lavage fluid. [ncbi.nlm.nih.gov]

  With a presumptive diagnosis of pneumonia, he was admitted with oxygen therapy and intravenous treatment with amoxicillin/clavulanic acid (100 mg/kg/day). The thrombocytosis was confirmed and considered to be possibly reactive. [analesdepediatria.org]

  Mycoplasma pneumoniae infection in a clinical setting. Pediatr Int. 2008;50:662–666. 8. Matsubara K, et al.. Age-dependent changes in the incidence and etiology of childhood thrombocytosis. Acta Haematol. 2004;111:132–137. 9. O'Shea J, et al.. [journals.lww.com]

  Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Comparison of a plugged telescoping catheter with the protected specimen brush. [bja.oxfordjournals.org]

• Intestinal Disease

  Abstract Six patients with either ulcerative or granulomatous intestinal disease were noted to have markedly elevated concentrations of circulating blood platelets during a period of increased clinical activity of their bowel disorders. [annals.org]

  One possible underlying intestinal disease associated with impaired iron absorption is celiac disease [ 3, 4 ]. [jmedicalcasereports.com]

• Chest Pain

  Following the procedure, there was no chest pain. His platelet count was 388,000/mm3. He was discharged on medical therapy following an uneventful hospital course. [ncbi.nlm.nih.gov]

  pain was referred to our center. [imagebank.hematology.org]

  pain or burning / paresthesias of the fingers or toes suggestive of digital ischemia). [tcd.ie]

  People with essential thrombocythemia might have signs and symptoms related to blood clots and bleeding, including: Headache Dizziness or lightheadedness Chest pain Weakness Numbness or tingling of the hands and feet When to see a doctor Because thrombocytosis [mayoclinic.org]

• Tachycardia

  CONCLUSIONS: Although clinicians often use tachycardia and low oxygen saturation as triggers to order PE imaging studies, these signs have a very low specificity. [ncbi.nlm.nih.gov]

• Epistaxis

  Bleeding is usually mild, rarely spontaneous, and manifests as epistaxis, easy bruisability, or GI bleeding. However, serious bleeding may occur in a small percentage of cases with extreme thrombocytosis. [merckmanuals.com]

  Spontaneous bleeding from the gastrointestinal and genitourinary tracts, hemoptysis, and epistaxis is known; while ischemia of digits progressing to limb-threatening gangrene, cerebrovascular ischemia causing neurological complications, intra-abdominal [joacp.org]

• Headache

  Identification of specific headache types in patients with ET may enable physicians to employ the most effective headache medication. [doi.org]

  A 32-year-old woman presented with headaches of increasing severity that began approximately 3 years ago. [jamanetwork.com]

  Fifth day of hospitalisation : the patient had headache, more severe abdominal pain, a worsening of the right pleural effusion and increasing thrombocytosis. [analesdepediatria.org]

  People with essential thrombocythemia might have signs and symptoms related to blood clots and bleeding, including: Headache Dizziness or lightheadedness Chest pain Weakness Numbness or tingling of the hands and feet When to see a doctor Because thrombocytosis [mayoclinic.org]

  When they occur, they may include: Headache Dizziness or lightheadedness Chest pain Weakness Fainting Temporary vision changes Numbness or tingling of the hands and feet Causes The bones contain a spongy tissue, the bone marrow, which has stem cells that [humanitas.net]

• Dizziness

  The clinical presentation is similar to sporadic essential thrombocythemia (ET; see this term) and may include impaired microcirculation resulting in brief episodes of fainting and dizziness, an increased risk of thrombotic events, hemorrhage, and mild [orpha.net]

  People with essential thrombocythemia might have signs and symptoms related to blood clots and bleeding, including: Headache Dizziness or lightheadedness Chest pain Weakness Numbness or tingling of the hands and feet When to see a doctor Because thrombocytosis [mayoclinic.org]

• Lethargy

  Clinical symptoms include shortness of breath, lethargy and heart palpitations. [digitalnaturopath.com]

  The symptoms of anemia are reduced energy, lethargy, exertional dyspnea, cardiac palpitations, and, when extreme, coronary insufficiency or other end organ ischemia. [cancertherapyadvisor.com]

A preliminary physical examination to study the signs and symptoms of the disease followed by blood tests to check for levels of platelets forms the basis of treatment regime. Physical examination would reveal splenomegaly, or may show signs of infection.

These tests are done along with blood smear test, which is required to study the condition of platelets. A platelet count beyond 500,000 microliter of blood suggests that there is an underlying disease condition that is causing thrombocytosis. In many cases, repeat blood tests would be ordered after specific period of time to check whether the platelets levels are constantly high [9].

In addition to the above mentioned tests, the following would also be required to diagnose thrombocytosis:

• Iron status 
• Inflammatory markers
• Genetic testing to diagnose bone marrow disease
• Bone marrow aspiration 

• Thrombocytosis

  […] primary Thrombocytosis familial thrombocytosis hereditary thrombocythemia hemorrhagic thrombocythemia Primary Thrombocythemia essential thrombocytemia ET essential thrombocytosis Idiopathic thrombocythemia Thrombocythemia type 1 THCYT1 THROMBOCYTHEMIA [wikidata.org]

  Reactive thrombocytosis occurs in response to infection, trauma, or surgery. Splenectomy alone accounts for 19% of all possible causes of extreme thrombocytosis. [ncbi.nlm.nih.gov]

• Colitis

  Amongst chronic inflammatory disorders causing thrombocytosis, Crohn’s disease (23 cases), colitis ulcerosa (15 cases), rheumatoid arthritis (11 cases) and chronic pancreatitis (nine cases) were the most common. [onlinelibrary.wiley.com]

  P; Bergamaschi, G Systematic review: managing anaemia in Crohn’s disease Kulnigg, S; Gasche, C Platelet count: a simple measure of activity in Crohn’s disease Harries, AD; Fitzsimons, E; Fifield, R; Dew, MJ; Rhoades, J Thrombocytosis in ulcerative colitis [deepdyve.com]

  Thrombocytosis in ulcerative colitis and Crohn’s disease. Scand J Gastroenterol. 1973;8(2):135–8. PubMed 70. Heits F, Stahl M, Ludwig D, Stange EF, Jelkmann W. [springermedizin.at]

Treating underlying condition can help resolve thrombocytosis. If infections are the cause, then platelet counts tend to remain high until the underlying cause is corrected. However, in cases, when the spleen has been removed, then individuals have to live with the condition of thrombocytosis for the rest of their life. In such situations, the affected individuals are given low dose aspirin in order to prevent blood clots [10].

With successful treatment of underlying condition, secondary thrombocytosis can be well managed, as the disorder does not cause blood clotting. The platelet counts return to normal after the infections have been treated or the disease condition properly addressed to. However, in individuals with primary thrombocytosis, there are higher chances of blood clotting and therefore individuals are given medications to keep the levels of platelet normal. After many years, such individuals can develop bone marrow fibrosis, which can eventually lead to onset of leukemia [7].

Several factors cause increase in the number of platelets in the blood. One of the major cause being bone marrow diseases, which cause the bone marrow to produce more megakaryocytes, triggering overproduction of platelets in blood. Other factors which also cause thrombocystosis include blood loss due to severe bleeding, myocardial infarction, infections, cancer, allergic reactions, kidney disorders, trauma, surgical procedures and conditions of pancreatitis. In addition to these factors, certain medications such as epinephrine, vincristine and tretinoin can also cause development of reactive thrombocytosis [2].

Reactive thrombocytosis is a common phenomenon unlike the primary type, with a postsplenectomy incidence rate of about 75 to 82% [3]. Statistics have also revealed that, secondary or the reactive form of thrombocytosis occurs in about 3 to 13% of children who are hospitalized.

About 6000 cases of primary thrombocytosis occur in the US every year. If young adults are considered to be affected by the condition, then more women are known to be affected than men. Such a type of disease condition rarely strikes the children population [4].

In the essential thrombocytosis, there is increased platelet count due to an underlying bone marrow disease. Bone marrow is a spongy material present within the bones, which contain stem cells that become white blood cells, platelets or red blood cells. Conditions that interfere with this mechanism causing excessive production of one of the blood components gives rise to the phenomenon of thrombocytosis. In bone marrow diseases, there is increased production of cells known as megakaryocytes, which in turn releases excessive amounts of platelets in the circulation [5].

On the other hand, the reactive or secondary form of thrombocytosis occurs due to increased production of proinflammatory cytokines, like interleukin 1, 6 and 11. Such a type of event primarily occurs in conditions of infections, chronic inflammation or malignancy [6].

So far no strategies have been designed to prevent thrombocytosis. However, steps can be taken to prevent the onset of complications. Adhering to a healthy lifestyle that includes quitting smoking, decreasing alcohol consumption and effective management of high blood pressure and diabetes can help prevent complications from occurring. Affected individuals are also advised against taking over the counter pain medications. It has also been advised that, individuals who are on blood thinning medications should tell the same to their doctor before undergoing any surgical procedures.

Thrombocytosis can be either primary or secondary in nature, depending on the causative factor. Excess production of platelets can call for onset of several conditions such as stroke, development of clot in blood vessels or myocardial infarction. When thrombocytosis is caused by an underlying disease condition, then it is termed as reactive or secondary thrombocytosis. In instances, when bone marrow diseases are the cause, then the condition is known as essential or primary thrombocytosis. Of the two forms, the latter one is more prone to favor the development of blood clots in affected individuals [1].

• Definition: Thrombocytosis is a condition, wherein there is increase in level of platelet counts beyond 500,000 per microliter of blood. There are 2 forms of thrombocytosis: primary and secondary. 
• Cause: Underlying disease conditions, infections, certain medications and surgery are known to cause elevated levels of platelet count. All these lead to development of secondary thrombocytosis. If bone marrow diseases favor the overproduction of platelets, then there is development of primary thrombocytosis.
• Symptoms: Symptoms of thrombocytosis include pain in chest, fatigue, weakness and changes in vision for temporary period. In addition, individuals can also suffer from tingling or numbness sensation in hands and feet.
• Diagnosis: At the primary level, a complete blood count would help evaluate the platelets levels in the blood. This would be followed by preliminary physical examination which would reveal signs of infection and an enlarged spleen. In addition, blood smear test and bone marrow aspiration are also indicated.
• Treatment: Treatment of thrombocytosis involves correcting the underlying disease condition which would gradually bring back the level of platelet count to normal again. However, in condition, when the spleen has been removed, then the patient has to be put on blood thinning medications for the rest of the life for preventing blood clots.

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3. Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Postsplenectomy reactive thrombocytosis. Proc (BaylUniv Med Cent). Jan 2009;22(1):9-12.
4. Mesa RA, Silverstein MN, Jacobsen SJ, Wollan PC, Tefferi A. Population-based incidence and survival figures in essential thrombocythemia and agnogenic myeloid metaplasia: an Olmsted County Study, 1976-1995. Am J Hematol. May 1999;61(1):10-5.
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7. Schafer AI. Thrombocytosis. N Engl J Med 2004; 350:1211.
8. Buss DH, Cashell AW, O'Connor ML, et al. Occurrence, etiology, and clinical significance of extreme thrombocytosis: a study of 280 cases. Am J Med 1994; 96:247.
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10. Low-dose aspirin in polycythaemiavera: a pilot study. GruppoItaliano Studio Policitemia (GISP). Br J Haematol 1997; 97:453.