Reactive thrombocytosis and thrombocythemia
Platelets are small cells responsible for stopping bleeding. Their number increases in two fundamentally different situations. In reactive thrombocytosis, the bone marrow works normally and only responds to signals of inflammation or blood loss - this is the most common option, especially in children and after surgery. With essential thrombocythemia, an acquired mutation occurs in a stem cell, and platelet production occurs without an external stimulus, regardless of the body's needs.
- Reactive - response to infection, inflammation, blood loss
- Thrombocytosis after surgery and removal of the spleen
- Thrombocytosis due to iron deficiency
- Essential thrombocythemia - a disease of the bone marrow
- Increased platelets in other myeloproliferative diseases
Symptoms
Reactive thrombocytosis usually has no symptoms and is discovered by chance. With essential thrombocythemia, complaints may also be absent for years. When symptoms appear, they are associated with impaired blood flow in small vessels: headache, dizziness, flashing spots, numbness and burning in the fingertips, redness and soreness of the feet and palms. Paradoxically, with a very high platelet count, the risk of bleeding also increases, since the cells are functionally inferior.
- Most often there are no complaints
- Headache and dizziness
- Flickering of flies before the eyes
- Burning and tingling in fingers
- Redness and pain in the feet and palms
- Bruises, nosebleeds
- Enlarged spleen
When promotion is dangerous
Danger is determined not so much by a number as by a combination of factors. The risk of thrombosis is higher in people over 60 years of age, in those who have already had a heart attack, stroke or vein thrombosis, as well as in those with a JAK2 mutation, smoking, hypertension and diabetes. It is based on these signs that the hematologist classifies the patient into a low or high risk group and decides whether drug therapy is needed. During pregnancy, monitoring is carried out jointly with an obstetrician-gynecologist.
- Age over 60 years
- Previous thrombosis or stroke
- Presence of JAK2 mutation
- Smoking, hypertension, diabetes, obesity
- Prolonged immobility, flights, operations
- Very high platelet count - risk of bleeding
Survey
The first step is to repeat a complete blood count in 1-2 weeks: often the increase is temporary. At the same time, they look for the hidden cause: they check inflammation indicators, iron reserves, and exclude chronic infection and tumor. If platelets are persistently elevated for no apparent reason, the hematologist will order testing for JAK2, CALR, and MPL mutations, an abdominal ultrasound to evaluate the spleen, and, if necessary, a bone marrow biopsy to confirm the diagnosis.
- Repeated general blood test with smear
- CRP and other inflammatory markers
- Ferritin and iron metabolism
- Coagulogram
- JAK2, CALR, MPL mutations
- Ultrasound of the abdomen and spleen
- Bone marrow biopsy as prescribed by a hematologist
Treatment and lifestyle
With reactive thrombocytosis, the cause is treated, and the platelet count returns to normal on its own; There is no need to specifically “thin the blood.” In essential thrombocythemia, management depends on the risk: for low-risk patients, observation and low-dose antiplatelet therapy are often sufficient; for high-risk patients, drugs that reduce cell production are added. Working with vascular factors is equally important: quitting smoking, controlling blood pressure, sugar and weight. All medications are selected by a hematologist; self-medication is unacceptable.
- Treatment of the underlying disease in reactive thrombocytosis
- Low dose antiplatelet agents as prescribed by a doctor
- Cytoreductive therapy at high risk
- Complete smoking cessation
- Control blood pressure, sugar and cholesterol
- Drinking enough and moving during long flights
- Regular monitoring of blood tests