From the Research
Elevated platelet count (thrombocytosis) generally does not increase your risk of bleeding; in fact, it more commonly increases your risk of blood clots. However, in certain conditions like essential thrombocythemia (a type of myeloproliferative disorder), extremely high platelet counts can paradoxically cause bleeding problems, as noted in a study published in the British Journal of Haematology 1. This occurs because very high platelet counts can lead to acquired von Willebrand disease, where large numbers of platelets bind to and remove von Willebrand factor from circulation, impairing normal clotting function. Additionally, in some myeloproliferative disorders, the platelets may be dysfunctional despite being elevated in number. Some key points to consider include:
- The relationship between thrombocytosis and vascular events is controversial, and solid evidence to support the use of cytoreductive therapy in patients with no other risk factors is lacking, as discussed in a study published in the British Journal of Haematology 1.
- Treatment of essential thrombocythaemia (ET) is directed at decreasing the risk of complications of the disease, including arterial and venous thrombosis and bleeding episodes, as noted in a study published in the American Journal of Hematology 2.
- The main goal of therapy in both polycythemia vera (PV) and ET is to prevent thrombohemorrhagic complications, and all patients with PV require phlebotomy to keep hematocrit below 45% and once-daily or twice-daily aspirin (81 mg), in the absence of contraindications, as recommended in a study published in the American Journal of Hematology 2. If you have elevated platelets, your doctor may recommend aspirin therapy to reduce clotting risk rather than treating for bleeding risk, but this depends on the underlying cause of your elevated platelet count and your overall clinical picture, as discussed in a study published in Cancer 3. It's essential to have your condition properly evaluated to determine the cause of your elevated platelets and the appropriate management strategy. In some cases, cytoreductive therapy may be recommended for high-risk ET and PV, but it is not mandatory for intermediate-risk ET, as noted in a study published in the American Journal of Hematology 2. Overall, the management of elevated platelet counts requires a comprehensive approach that takes into account the underlying cause of the condition and the individual patient's risk factors.