Thrombocytosis is a blood disorder in which the body produces a surplus of platelets (thrombocytes). Platelets are blood cells that stick together, helping blood to clot. Thrombocytosis is a condition that may have many causes.
Throbocytosis is classified as one of two types. 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.
While the cause of essential thrombocytosis is unknown, secondary thrombocytosis may develop as a result of many things including:
- acute hemorrhage or infection
- anemia
- arthritis and other chronic inflammations
- cancer
- exercise
- iron deficiency
- medication
- osteoporosis
- removal of the spleen (splenectomy)
- polycythemia vera (a disorder affecting other red blood cells, as well as platelets)
- stress
- surgery
Two-thirds of those with thrombocytosis do not have any symptoms of the disease at the time of diagnosis. Younger patients may remain symptom-free for years.
Enlargement of the spleen is detected in 60% of patients with thrombocytosis. The liver may also be enlarged. As many as half of all patients experience bleeding from the skin, gums, or nose; and 20-50% have some blockage of veins or arteries.
Other symptoms may include:
- bloody stools
- bruising
- dizziness
- headache
- hemorrhage
- prolonged bleeding after having surgery or after having a tooth pulled
- redness or tingling of the hands and feet
- weakness
- In rare cases, the lymph nodes become enlarged
The highest platelet counts usually produce the most severe symptoms. Younger patients (especially women) may not have symptoms, even though their platelet counts are very high.
Complications of thrombocytosis include stroke, heart attack, and formation of blood clots in the arms and legs.
A doctor should be notified whenever bleeding is unexplained, prolonged or the patient develops symptoms such as:
- chest or leg pain
- confusion
- numbness
- weakness
The patient’s symptoms suggest the presence of thrombocytosis. Blood tests confirm the diagnosis.
Bone marrow aspiration (removal of a tissue sample for microscopic examination) may also be performed.
Obviously, the key to treating secondary thrombocytosis is treating the underlying condition.
Any patient who has thrombocytosis should be encouraged not to smoke.
In young people who have no symptoms, this condition can remain stable for many years. These patients should be monitored by a physician, but may not require treatment.
Treatment for patients who do have symptoms focuses on controlling bleeding, preventing the formation of blood clots, and lowering platelet levels. Treatment for secondary thrombocytosis involves treating the condition or disease responsible for excess platelet production.
In 1997, the United States Food and Drug Administration (FDA) approved the use of anagrelide HCl (Agrylin) to reduce elevated platelet counts and decrease the risk of clot formation. Some patients have benefited from the use of hydroxyurea, an anticancer drug.
Low doses of aspirin may prevent clotting, but can cause serious hemorrhages.
If drug therapy does not bring platelet counts down to an acceptable level as rapidly as necessary, plateletpheresis may be performed.
Many patients with thrombocytosis remain free of complications for long periods. However, some patients may die as a result of blood clots or uncontrolled bleeding.
Signs, symptoms & indicators of Thrombocytosis
Black or tarry stools
(Possibly) enlarged spleen
Occasional/frequent nosebleeds
Numb/tingling/burning extremities
Red palms/fingertips
Conditions that suggest Thrombocytosis
Risk factors for Thrombocytosis
Thrombocytosis suggests the following may be present
Thrombocytosis can lead to
Leukemia, Acute Myelogenous (AML)
Evolution of primary thrombocytosis to frank acute myeloblastic leukemia (AML), myelofibrosis/AMM, or myelodysplastic syndrome (MDS) has been documented in adults and represents a progression of disease.
Recommendations for Thrombocytosis
Aspirin
Often, no treatment is required for reactive thrombocytosis. However, in primary thrombocytosis, with platelet counts over 750,000, and especially if there are other risk factors for thrombosis, aspirin at low doses is thought to be protective, and extreme levels are treated with hydroxyurea (a cytoreducing agent).
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| May do some good |
Glossary
Iron
An essential mineral. Prevents anemia: as a constituent of hemoglobin, transports oxygen throughout the body. Virtually all of the oxygen used by cells in the life process are brought to the cells by the hemoglobin of red blood cells. Iron is a small but most vital, component of the hemoglobin in 20,000 billion red blood cells, of which 115 million are formed every minute. Heme iron (from meat) is absorbed 10 times more readily than the ferrous or ferric form.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Hemorrhage
Profuse blood flow.
Anemia
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Arthritis
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Red Blood Cell
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Lymph Nodes
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit and groin, but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Children’s nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's.
Stroke
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Aspiration
Inhalation, or removal of fluids or gases from a cavity using suction.
FDA
The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.
Hydrochloric Acid
(HCl): An inorganic acidic compound, excreted by the stomach, that aids in digestion.
Plateletpheresis
This procedure consists of withdrawing blood from the patient's body, removing platelets from the blood and then returning the platelet-depleted blood to the patient
Leukemia
Cancer of the lymph glands and bone marrow resulting in overproduction of white blood cells (related to Hodgkin's disease).