Are your platelets high? Let's talk about Thrombocytosis!

Have you also been diagnosed with high platelets in your blood? Or does someone you know have this condition? It's normal to feel a little nervous when you hear something like this. But don't worry, today we will talk about this condition called Thrombocytosis in a simple way that you can understand.

What is thrombocytosis? Simply put…

Simply put, thrombocytosis is when you have too many platelets in your blood. Now you may be asking, “What are platelets?” That’s a very important question!

Platelets are a type of small cell found in our blood. Their main function is to stop bleeding when there is a bleed, such as when there is a wound. They act like a small dam.

But what happens if the number of platelets increases too much? Your blood can become thick and sticky. In some severe cases, these excess platelets can cause dangerous blood clots to form inside the blood vessels. This can increase the risk of conditions like stroke or heart attack .

However, not all cases of Thrombocytosis are equally dangerous. The severity of the condition, and whether you need treatment or not, depends on the cause.

There are two main types of thrombocytosis:

Yes, doctors have identified two main types of this condition. Let's talk about that a little bit.

1. Essential Thrombocythemia (ET) or Primary Thrombocytosis

This is a rare blood disorder. It occurs when your bone marrow – the blood cell factory inside your bones – produces too many platelets. Think about it, most of the blood cells in our bodies are made in this bone marrow. A person with essential thrombocythemia has an abnormally high production of platelets due to a defect in this blood cell production process.

This condition, called ET (Essential Thrombocythemia) , is considered the most common disease in the blood group called Myeloproliferative Neoplasm (MPN) .

2. Reactive Thrombocytosis or Secondary Thrombocytosis

This is the most common type of Thrombocytosis. This is when your body makes more platelets in response to another condition, such as an infection, injury, surgery, or removal of your spleen. Simply put, your body is “reacting” to something else and your platelet levels are elevated. This condition, called Reactive Thrombocytosis , is often temporary. That is, once the original cause is resolved, your platelet count will return to normal.

Who gets thrombocytosis?

This condition is most often diagnosed in people over the age of 60. Also, it is reported that a type called Essential Thrombocythemia (ET) is diagnosed in women twice as often as in men.

What are the causes of thrombocytosis?

The reasons for the two types we discussed earlier are also different.

Causes of Essential Thrombocythemia (ET)

Essential Thrombocythemia (ET) is an acquired genetic condition. It is not something you are born with. It is caused by changes, or mutations, in certain genes involved in the production of platelets. This causes your bone marrow to produce too many platelets.

More than half of people with Essential Thrombocythemia (ET) have a mutation in the JAK2 gene. Mutations in the CALR or MPL genes are also common.

Scientists still have not been able to pinpoint exactly what causes these gene mutations, but research into it continues.

Causes of Reactive Thrombocytosis

This type occurs because your body produces more platelets in response to various conditions. Or, sometimes, it can also be because old platelets accumulate instead of being destroyed at the normal rate.

Here are some things that can cause Reactive Thrombocytosis :

• Anemia , especially iron deficiency anemia.
• Other blood disorders.
• Some types of cancer .
• Infections, such as pneumonia .
• Inflammatory conditions – conditions that cause inflammation in the body, such as rheumatoid arthritis.
• Injury .
• Kidney failure .
• Some medications.
• Surgery, especially abdominal surgery.
• Spleen removal.
• Treating vitamin B12 deficiency.

This list only includes a few common causes. There can be many other causes of Reactive Thrombocytosis .

What are the symptoms of thrombocytosis?

Often, people with high platelet counts do not experience any symptoms, at least not in the early stages. If you have Reactive Thrombocytosis , you may experience symptoms of the underlying medical condition that caused it.

However, when symptoms do occur, they are often related to abnormal bleeding and blood clotting in your body. You may see symptoms like:

• Headache .
• Easily bruised.
• Feeling weak, dizzy, or lightheaded.
• Bleeding from the nose, mouth, and gums.
• Bleeding in the stomach or intestines.

Some people with Essential Thrombocythemia (ET) may develop a condition called Erythromelalgia . This causes pain, swelling, and redness in the hands and feet. They may also experience numbness and tingling in the hands and feet.

In severe cases, thrombocytosis can lead to abnormal blood clots in the abdomen (e.g., Budd-Chari syndrome ) and increase the risk of stroke or heart attack .

How is thrombocytosis diagnosed?

Because thrombocytosis usually does not cause symptoms, the first clue you have is if a routine blood test (e.g., Complete Blood Count – CBC ) shows an increased platelet count.

Thrombocytosis is defined as having more than 450,000 platelets per microliter of blood. If your platelet count is high, your doctor will likely order another blood test in a few weeks to see if the level remains high. A one-time increase in platelet count and then a return to normal is not usually a problem. However, persistently high levels may indicate an underlying medical condition.

In the case of reactive thrombocytosis , identifying the underlying condition that caused it (e.g., iron deficiency anemia , cancer, infection) can help doctors diagnose and manage it. However, if the doctor cannot find such a secondary cause, they will do further tests to see if you have Essential Thrombocythemia (ET) .

These tests may include:

• Peripheral blood smear: This checks to see if the platelets in your blood look abnormal.
• DNA/genetic tests: This can detect genetic mutations such as JAK2 , which are commonly associated with ET (Essential Thrombocythemia) .
• Bone marrow biopsy: This checks your bone marrow for abnormal cells.

How is thrombocytosis treated?

If you have no symptoms, you may only need routine checkups.

Reactive thrombocytosis (secondary thrombocytosis) often does not require treatment. Usually, platelet levels return to normal once the condition that caused the high platelet count (such as an injury, infection, or reaction to surgery) resolves. However, if you have symptoms, your doctor will treat the underlying cause.

If you have Essential Thrombocythemia (ET) and are experiencing symptoms, your doctor may recommend several treatments, such as:

• Taking a low-dose aspirin daily: You can take aspirin daily to prevent blood clots. This low dose usually does not cause stomach upset or bleeding. However, do not take aspirin regularly without talking to your doctor.
• Taking medications that lower platelet levels: Medications such as Hydroxyurea (brand names: Droxia®, Hydrea®, Siklos®, Mylocel®) and Anagrelide (brand name: Agrilyn®) reduce the production of platelets in the bone marrow. Interferon alfa (brand name: Multiferon®) prevents the abnormal platelets from dividing and multiplying.
• Having a procedure to remove your platelets: If your platelet levels are so high that you are at risk of developing life-threatening blood clots, your doctor may recommend a procedure called plateletpheresis . This involves using a machine to filter out the excess platelets from your blood. However, in most cases of thrombocytosis , plateletpheresis is not necessary.

Important: Do not start or stop any of these treatments without medical advice. Everything should be discussed with your doctor and done under his or her guidance.

Can thrombocytosis be completely cured?

There is currently no cure for Essential Thrombocythemia (ET) . However, your doctor can help you manage the condition to reduce your risk of blood clots. In the case of Reactive Thrombocytosis (caused by secondary causes), platelet levels usually return to normal once the underlying cause is treated.

Can thrombocytosis be prevented?

Many conditions that cause thrombocytosis cannot be prevented, including Essential Thrombocythemia (ET) .

Is thrombocytosis life-threatening?

High platelet levels are not life-threatening, but complications that can occur – such as blood clots or severe bleeding – can be dangerous.

Most causes of thrombocytosis are temporary, and they rarely lead to serious blood clots. In Essential Thrombocythemia (ET) , the risk is slightly higher. However, your doctor will monitor you closely, prescribe the necessary medications, and perform the necessary procedures to prevent dangerous blood clots. So don't worry.

What is the outlook for someone with thrombocytosis?

Reactive thrombocytosis usually resolves when the underlying problem is treated. Although your platelet count may be elevated for a short time (and possibly long-term after your spleen is removed), secondary thrombocytosis usually does not cause abnormal blood clots.

Essential Thrombocythemia (ET) , or primary thrombocytosis, can cause severe bleeding or blood clotting complications. Taking medication to keep your platelet levels normal can help prevent this. However, after many years of having the disease, bone marrow fibrosis (scarring of the bone marrow) can occur. A small number of people with Essential Thrombocythemia (ET) can also develop leukemia .

When should I see my doctor?

Follow your doctor's instructions exactly about how often you should go for medical checkups and whether you should have blood tests to check your platelet count.

When should I go to the Emergency Department (ETU) ?

If you experience symptoms of a stroke or heart attack, call 1990 immediately or go to the nearest hospital emergency room. Be aware of these symptoms.

What questions should I ask my doctor?

You can ask your doctor questions like:

• Should I be worried about my high platelet levels?
• Will I need to have more tests to check my platelet levels again?
• What tests will I need to do to find out the cause of my Thrombocytosis?
• What treatments do you recommend?
• What changes can I make in my lifestyle to manage this condition?

If your blood test results show that your platelets are high, don't panic. Your platelets can be high for a variety of reasons. Many of these reasons don't require treatment. But if your levels are consistently high and you have symptoms, your doctor will try to find the cause. Careful monitoring and medication can usually prevent the most serious complications associated with thrombocytosis.

Finally, things to remember (Take-Home Message)

Well, we talked a lot about Thrombocytosis today, didn't we? I hope you have a good understanding of this.

The most important thing is not to panic if you find out that your platelet levels are high. Not all cases of Thrombocytosis are dangerous.

• Reactive Thrombocytosis is the most common type, and it is usually caused by another temporary cause. This will also improve once that cause is treated.
• Essential Thrombocythemia (ET) is a rare type that may require long-term management.
• Be sure to undergo the appropriate tests and treatments as prescribed by your doctor.
• Do not ignore any symptoms. Seek immediate medical attention, especially if you have unusual bleeding, bruising, severe headache, chest pain, or difficulty breathing.
• Talk openly with your doctor. Ask any questions or concerns you have.

Remember, you are not alone. With proper medical guidance and support, you can manage this condition well and live a healthy life.