Thrombocytosis: When the Platelet Count is Too High
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Thrombocytosis: When the Platelet Count is Too High

Elevation of the platelet count is called thrombocytosis.

Thrombocytosis, an elevated platelet count, can result from a variety of etiologies, the most common of which is reactive (secondary) thrombocytosis, which studies suggest accounts for 87-96 percent of individuals with platelet counts in excess of 500,000 platelets per microliter, compared to the normal range which is 140-450,000 platelets per microliter. Reactive thrombocytosis can result from tissue damage resulting from an injury, or of a surgical procedure. Exercise-induced thrombocytosis is another cause, but to develop thrombocytosis this way, you would have to exercise a huge amount. Additionally, thrombocytosis can be essential (also called primary thrombocytosis), which is to say having no specific known cause. Since a high platelet count can be a sign of a serious illness that is in development, following a finding of elevated platelets in a complete blood count (CBC), a continued workup is warranted.

Evaluation for iron deficiency may be included in the workup of a patient, since iron deficiency is one possible cause of thrombocytosis. Tests such as erythrocyte sedimentation rate (ESR) and C reactive protein can reveal whether an inflammatory process is occurring as this also can provoke thrombocytosis. Cancer needs to be ruled out as well, since this also can be the cause of the high platelet count, very often reactive thrombocytosis turns out to be the reason for high platelet counts discovered incidentally.

It is smart to consider possible complications of thrombocytosis, and how the risks vary depending on what the etiology proves to be for any particular patient. In most instances, primary thrombocytosis (essential thrombocytosis) is part of myeloproliferative disorders which are categorized into four categories: essential thrombocytosis, primary myelofibrosis, chronic myelogenous leukemia, and polycythemia vera. When thrombocytosis develops in the context of one of these conditions, the risk of thrombosis –clotting- is elevated. This can occur in the cerebra arteries, as well as in portal vein and in deep veins when it is known as a deep venous thrombosis (DVT), a clot of deep veins, and this can lead to a pulmonary embolism. In contrast, the risk of clotting is not elevated in reactive thrombocytosis, unless the condition causing the reaction is itself associated with increased clotting complications, as in the case of malignancy for example. Whatever the reason for the thrombocytosis, in cases when the platelet count is extremely high, meaning more than 1,500,000 platelets per microliter, there actually is an increase in bleeding complications, ironically, as a result of acquired von Willebrand disease.

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