Thrombocytosis is a condition when the number of platelets in the blood exceeds the normal limit . Although rare, this condition can trigger several serious diseases due to the formation of abnormal blood clots, such as stroke and heart attack.

Thrombocytes or platelets are blood platelets produced by the bone marrow. Platelets play a role in the blood clotting process . When bleeding occurs, these blood pieces work by sticking together to form clots, so that the bleeding stops.

In patients with thrombocytosis, the bone marrow produces excessive platelets. As a result, platelets can form blood clots that shouldn't be there. Serious problems can occur if the blood clot blocks blood vessels in important organs, such as the brain and heart.

Causes of Thrombocytosis

Based on the cause, thrombocytosis is divided into two, namely:

Primary thrombocytosis

Primary thrombocytosis occurs due to a disorder in the bone marrow, which makes the bone marrow produce platelets excessively. This condition is more often experienced by people aged 50-70 years and women aged under 40 years.

The cause of the bone marrow disorder is not yet known. However, in some cases, this condition occurs due to genetic abnormalities or mutations.

Secondary thrombocytosis

Secondary thrombocytosis occurs due to a disease or other condition that causes the bone marrow to produce more platelets . These conditions include:

  • Infection
  • Cancer, especially lung, breast, and uterine cancer
  • Iron deficiency anemia
  • Hemolytic anemia
  • Inflammation, such as rheumatoid arthritis and inflammatory bowel disease
  • Surgery, especially spleen removal surgery
  • Hemolysis or abnormal destruction of red blood cells
  • The use of drugs, such as epinephrine , tretinoin , vincristine , or heparin sodium

Symptoms of Thrombocytosis

The normal number of platelets in human blood is 150,000–450,000 per microliter of blood. A person is said to have thrombocytosis if the number of platelets is above 450,000 per microliter of blood.

An increase in the number of platelets tends to rarely show symptoms. Generally, sufferers only find out that they have thrombocytosis during a medical check-up or when the doctor does a blood test.

However, there are also some sufferers who feel symptoms. Usually, symptoms of thrombocytosis occur due to the presence of blood clots. In each person, the symptoms felt can be different, depending on where the blood clot occurs.

The following are some symptoms of thrombocytosis that can appear:

  • Dizziness or headache
  • Chest hurts
  • Body limp
  • Tingling in the hands or feet
  • Visual impairment

In some cases, when the increase in the level of platelets is over 1 million per microliter of blood, the symptoms that can occur are bleeding. This is due to the decrease in the quality of platelets in the blood, even though the number is very large. At this stage, symptoms that can occur include:

  • Bruises on the skin
  • Nosebleed
  • Bleeding gums
  • Pass bloody stools

The above symptoms are more common in primary thrombocytosis. Even so, do not rule out the possibility that secondary thrombocytosis can also cause symptoms, especially if the underlying cause is not addressed.

When should you go to the doctor?

Check with your doctor if you experience the symptoms and complaints mentioned above. Examination and treatment of thrombocytosis early on will increase the chance of recovery and minimize the possibility of complications.

If you suffer from a disease or condition that can trigger thrombocytosis, do a routine checkup with a doctor. This is intended so that the condition you suffer from can be monitored and dealt with accurately, so that you avoid complications, including thrombocytosis.

Diagnosis of Thrombocytosis

Thrombocytosis is generally found accidentally during a routine blood test . In this case, the patient will be recommended to undergo a series of other examinations to confirm the diagnosis.

To diagnose thrombocytosis, initially the doctor will ask questions about the symptoms and complaints the patient may have, the history of infection, and the history of the patient's general health condition. Next, the doctor will perform a thorough physical examination.

The doctor will also perform some supporting examinations in order to obtain a more accurate diagnosis. Some of those checks are:

  • Blood smear test , to see the size of platelets
  • Blood clotting test
  • Platelet aggregation test, to see platelet function

Once the patient is known to be suffering from thrombocytosis, the doctor will carry out further examinations to find out the cause. Some of the checks that may be done are:

  • Bone marrow aspiration
  • Blood iron level test
  • Inflammatory marker tests, such as CRP ( C-Reactive protein ) levels

It should be noted that platelet counts should also be checked when  splenomegaly is detected  or there are signs of infection.

Treatment of Thrombocytosis

Thrombocytosis patients who do not experience symptoms and whose condition is stable only need routine examination. While for patients who experience symptoms, the treatment can be done based on the type of thrombocytosis, namely:

Primary thrombocytosis

Generally, the treatment of primary thrombocytosis is performed in patients who have the following conditions:

  • Aged above 60 years
  • Have a history of bleeding or blood clotting
  • Having risk factors for heart disease, such as diabetes , high cholesterol, or high blood pressure (hypertension)

Some treatment methods that doctors can do include:

  • The administration of aspirin, to reduce blood clotting
  • Administration of drugs such as hydroxyurea or interferon , to suppress the production of platelets by the bone marrow
  • Platelet pheresis procedure , to separate platelets from the bloodstream, which is done if platelet production cannot be rapidly reduced with drugs

Secondary thrombocytosis

Treatment of secondary thrombocytosis is aimed at overcoming the condition that causes thrombocytosis. By overcoming the cause, the number of platelets can return to normal.

If the cause is injury or surgery, then the increase in the number of platelets will usually not last long and can return to normal on its own. However, if the cause is a chronic infection or inflammatory disease, the platelet count will remain high until the cause can be controlled.

On the other hand, operation to remove the spleen (splenectomy) can cause lifelong thrombocytosis. Even so, no special treatment is usually needed to lower the number of platelets in this condition.

Complications of Thrombocytosis

If not treated correctly, thrombocytosis can cause serious complications, such as:

  • Heavy bleeding
  • Disorders due to blood clotting, such as deep vein thrombosis (DVT), stroke, pulmonary embolism, even heart attack
  • Miscarriage or fetal development problems in pregnant women

Prevention of Thrombocytosis

Thrombocytosis is difficult to prevent. The best effort that can be made is to reduce the risk of conditions that can trigger thrombocytosis. This can be achieved by changing a healthier lifestyle, such as:

  • Eat a balanced diet, such as vegetables or fruits
  • Maintain an ideal weight
  • Stop smoking
  • Exercise regularly
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