Edit concept Question Editor Create issue ticket

Thrombocytosis

Thrombocythemia

Thrombocytosis is a condition, characterized by excess production of thrombocytes. Such a type of disorder can cause development of thrombosis in affected individuals.


Presentation

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].

Palpable Spleen
  • Examination revealed mild hepatomegaly with palpable spleen tip. Haemogram and peripheral smear revealed moderate leucocytosis with extreme thrombocytosis (2,800,000/mm(3)).[ncbi.nlm.nih.gov]
Intermittent Fever
  • Abstract We report a 5 years old male child with low serum IgG, IgA and IgM levels, who presented with recurrent perianal and oral ulcers, intermittent fever, and protracted diarrhea.[ncbi.nlm.nih.gov]
Exertional Chest Pain
  • He had no recent history of change in his energy level, limitations to activity, exertional chest pain, or shortness of breath. He had cardiac risk factors, including a strong family history of pre-mature coronary artery disease and dyslipidemia.[ncbi.nlm.nih.gov]

Workup

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
  • Out of 12 patients (5.9%) with thrombocytosis, 9 (4.3%) had transient thrombocytosis and 3 patients (1.4%) had persistent thrombocytosis.[ncbi.nlm.nih.gov]
  • The purposes of our research were to examine the role of thrombocytosis in inflammatory breast cancer (IBC) and to know which cytokine drives thrombocytosis.[ncbi.nlm.nih.gov]
  • We assessed the onset of thrombocytosis within the third cycle of therapy and the relation between thrombocytosis and survival. RESULTS: We included 318 patients. Thrombocytosis occurred in 156 patients (49.1%).[ncbi.nlm.nih.gov]
  • INTRODUCTION: Thrombocytosis is common following elective splenectomy and major trauma. However, little is known about the in-hospital course of platelet count (PC) and incidence of thrombocytosis after splenic trauma.[ncbi.nlm.nih.gov]

Treatment

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].

Prognosis

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].

Etiology

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].

Epidemiology

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].

Sex distribution
Age distribution

Pathophysiology

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].

Prevention

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.

Summary

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].

Patient Information

  • 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.

References

Article

  1. Kutti J, Wadenvik H. Diagnostic and differential criteria of essential thrombocythemia and reactive thrombocytosis. Leuk Lymphoma. Sep 1996;22suppl 1:41-5.
  2. Hoffman R. Primary thrombocythemia. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. Philadelphia, Pa: Churchill Livingstone; 2000:1188-204.
  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.
  5. Bucalossi A, Marotta G, Bigazzi C, Galieni P, Dispensa E. Reduction of antithrombin III, protein C, and protein S levels and activated protein C resistance in polycythemia vera and essential thrombocythemia patients with thrombosis. Am J Hematol. May 1996;52(1):14-20.
  6. Tefferi A, Ho TC, Ahmann GJ, Katzmann JA, Greipp PR. Plasma interleukin-6 and C-reactive protein levels in reactive versus clonal thrombocytosis. Am J Med. Oct 1994;97(4):374-8.
  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.
  9. Messinezy M, Westwood N, Sawyer B, et al. Primary thrombocythaemia: a composite approach to diagnosis. Clin Lab Haematol 1994; 16:139.
  10. Low-dose aspirin in polycythaemiavera: a pilot study. GruppoItaliano Studio Policitemia (GISP). Br J Haematol 1997; 97:453.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 10:21