From the Guidelines
A platelet count of 700 × 10^9/L is significantly elevated, indicating thrombocytosis that requires immediate medical attention to mitigate the risk of thrombosis and bleeding complications. This condition is associated with an increased risk of blood clots and, paradoxically, bleeding complications due to various qualitative platelet defects, such as diminished response of platelet adenylate cyclase to prostaglandin D2 and increased baseline platelet production of thromboxane A2 1. The underlying cause of thrombocytosis can be either reactive (due to infection, inflammation, iron deficiency) or primary (from bone marrow disorders like essential thrombocythemia or polycythemia vera) 1.
Key Considerations
- The elevated platelet count may be associated with a baseline pro-thrombotic state, characterized by reduced levels of physiologic anticoagulants (antithrombin III, proteins C and S) and decreased fibrinolytic activity 1.
- Acquired von Willebrand disease, which occurs in more than a third of patients with polycythemia vera, can lead to a bleeding diathesis due to decreased large von Willebrand factor multimers and increased cleavage products 1.
- Treatment depends on the underlying cause and risk factors but often includes low-dose aspirin (81-100 mg daily) to reduce clotting risk, and for severe cases or those with additional risk factors, cytoreductive therapy such as hydroxyurea may be prescribed 1.
Diagnostic Approach
- A complete blood count, peripheral blood smear, and possibly bone marrow evaluation are typically needed to determine the cause and guide appropriate treatment.
- It is essential to identify the underlying cause of thrombocytosis to provide targeted treatment and prevent complications.
- Hydration and avoiding prolonged immobility are important supportive measures to reduce the risk of thrombosis.
From the Research
Significance of Thrombocytosis
A platelet count of 700 indicates thrombocytosis, which can be classified into primary and secondary types.
- Primary thrombocytosis is often associated with myeloproliferative neoplasms, such as essential thrombocythemia, and can lead to thrombotic and hemorrhagic complications 2, 3, 4.
- Secondary thrombocytosis is more common and can be caused by various factors, including tissue injury, infection, chronic inflammatory disorders, and iron deficiency anemia 3, 5, 4.
Clinical Implications
Thrombocytosis can increase the risk of thrombotic complications, particularly in patients with primary thrombocytosis 2, 3, 6.
- Patients with a high platelet count, such as 700, may require therapy to reduce their risk of thrombotic complications, including antiplatelet agents and cytoreductive therapy 2, 6.
- The management of thrombocytosis depends on the underlying cause and the patient's risk factors, and may involve regular monitoring of platelet counts, control of cardiovascular risk factors, and treatment with antiplatelet agents or cytoreductive therapy 2, 5, 6.
Diagnostic Approach
The diagnostic approach to thrombocytosis involves distinguishing between primary and secondary causes, and identifying any underlying conditions that may be contributing to the elevated platelet count 2, 3, 4.