Thrombocytosis

Overview

Thrombocytosis (throm-boe-sie-TOE-sis) is a disorder in which your body produces too many platelets. Platelets are parts of the blood that help form blood clots. Thrombocytosis can be categorized into two types: reactive thrombocytosis or secondary thrombocytosis, which occurs due to an underlying condition such as an infection, and primary thrombocythemia or essential thrombocythemia, which is a blood and bone marrow disease with no apparent underlying cause. A high platelet count may be detected in a routine blood test known as a complete blood count. It's important to determine whether it's reactive thrombocytosis or essential thrombocythemia to choose the best treatment options.

Understanding the disease

Symptoms

The symptoms of thrombocytosis may include:

1. Headache.
2. Confusion or changes in speech.
3. Chest pain.
4. Shortness of breath and nausea.
5. Weakness.
6. Burning pain in the hands or feet. Less commonly, very high platelet levels may cause bleeding, which can result in:
7. Nosebleeds.
8. Bruising.
9. Bleeding from your mouth or gums.
10. Bloody stool. Please note that these symptoms may also be associated with other medical conditions, so it's essential to consult with a healthcare provider for an accurate diagnosis.

Development

Thrombocytosis, or the production of too many platelets in the blood, can develop in two main ways: primary and secondary.

1. Primary Thrombocytosis: Also known as essential thrombocythemia, this type occurs when there is no apparent underlying condition causing the high platelet count. It's considered a blood and bone marrow disease. The cause of primary thrombocytosis is often related to changes in certain genes, causing the bone marrow to produce too many platelet-forming cells.
2. Secondary Thrombocytosis: This type, also known as reactive thrombocytosis, occurs when an underlying condition triggers the production of too many platelets. Common underlying causes include:

• Blood loss
• Cancer
• Infections
• Iron deficiency
• Removal of the spleen
• Hemolytic anemia
• Inflammatory disorders, such as rheumatoid arthritis, sarcoidosis, or inflammatory bowel disease
• Surgery and other traumas It is essential to determine whether thrombocytosis is primary or secondary to choose the most appropriate treatment options.

Assessment and Diagnosis

Triage

If you or your child has symptoms that are concerning, such as persistent or severe headache, confusion, chest pain, or easy bruising, it would be appropriate to see a doctor. In cases of suspected thrombocytosis, it is essential to determine whether it is primary or secondary thrombocythemia, as this will impact the best treatment options. Additionally, bleeding that cannot be controlled with usual first aid techniques, such as applying pressure, is a medical emergency and requires immediate attention.

Diagnosis

To diagnose thrombocytosis, a blood test called a complete blood count (CBC) can be performed to determine if your platelet count is too high. Additional blood tests may be conducted to check for factors such as high or low iron levels, markers of inflammation, and gene mutations. In some cases, a bone marrow aspiration may be performed to collect a sample for testing.

Management and Treatment

Complications

Thrombocytosis is a condition in which the body produces too many platelets, increasing the risk of clotting and bleeding complications. Potential complications associated with thrombocytosis include:

1. Blood clots: The excess platelets can form blood clots in the arteries or veins, leading to conditions like deep vein thrombosis or pulmonary embolism.
2. Strokes: Blood clots can also travel to the brain, causing a stroke or transient ischemic attack (TIA).
3. Heart attacks: Thrombocytosis increases the risk of blood clots in the coronary arteries, which may result in a heart attack.
4. Cancer: Rarely, essential thrombocythemia, a type of thrombocytosis, may progress to a type of leukemia that advances rapidly.
5. Pregnancy complications: Uncontrolled thrombocytosis may increase the risk of miscarriage and other pregnancy complications. Regular checkups and medication can help reduce these risks.
6. Hepatitis: Mild liver inflammation (hepatitis) may occur in some cases.
7. Jaundice: Yellowing of the skin and whites of the eyes (jaundice) can sometimes occur.
8. Other complications: Less common complications may include anemia, thrombocytopenia (low platelet count), heart problems, complications involving the nervous system, and swollen tonsils that can obstruct breathing.

Treatment

Treatment for thrombocytosis depends on the underlying cause and the presence of symptoms. If the condition is due to an underlying condition, treating the underlying cause may lower the platelet count. If there are no underlying conditions, the following treatments may be considered:

1. Aspirin and anti-platelet drugs: These medications help reduce the risk of blood clots and can be used to manage symptoms related to thrombocytosis.
2. Anticoagulants: These drugs help prevent the formation of blood clots. Heparin is fast-acting and may be used short-term in the hospital, while warfarin (Jantoven) is a slower-acting option for long-term use, requiring regular blood tests to monitor its effects.
3. Compression stockings: Wearing compression stockings can help improve blood flow and reduce the risk of blood clots in the legs.
4. Blood thinner medications: These drugs, such as heparin or warfarin, are used to prevent the formation of blood clots. However, they carry a risk of bleeding side effects, so regular blood tests are necessary while taking these medications. It's important to consult with a healthcare professional to determine the best treatment options based on individual circumstances and medical history.

Preparing for medical consultation

To prepare for an appointment for thrombocytosis, you should:

1. Make a list of your symptoms and when they began, including any unusual bruising, rashes, or bleeding.
2. Gather information about your medical history, recent infections, surgical procedures, bleeding, and anemia.
3. Compile a list of all medications, vitamins, and supplements you take, including doses.
4. Bring a family member or friend along to help you remember the information discussed during the appointment.
5. Prepare a list of questions to ask your doctor, such as the cause of your thrombocytosis, recommended treatment options, potential side effects, and whether you need to restrict your activity.
6. Be aware of any pre-appointment restrictions, such as dietary limitations or medication adjustments.
7. Inform your doctor about any over-the-counter medications you are taking, as some can increase bleeding risk. By gathering this information and being well-prepared, you can ensure a productive and informative appointment with your doctor.