Mild Thrombocytosis: No Treatment Required
A platelet count of 389 × 10⁹/L represents mild thrombocytosis that does not require any treatment or intervention. This count falls within the range where reactive (secondary) thrombocytosis is most likely, and cytoreductive therapy is never indicated below 1,500 × 10⁹/L. 1
Clinical Significance
Your platelet count is only slightly above the upper limit of normal (150-450 × 10⁹/L) and is classified as mild thrombocytosis. 1 This elevation is almost certainly reactive, meaning it's a response to another condition rather than a primary blood disorder. 2, 3
Key points about your platelet count:
- No bleeding or clotting risk: A count of 389 × 10⁹/L does not increase your risk of bleeding during procedures—in fact, guidelines only recommend platelet transfusions when counts fall below 50 × 10⁹/L for major surgery. 1
- No activity restrictions needed: You can continue all normal activities without modification. 1
- No medication required: Cytoreductive therapy (medications to lower platelet counts) is not indicated unless counts exceed 1,500 × 10⁹/L in secondary thrombocytosis. 1
What You Should Do
Investigation for Underlying Causes
While your platelet count itself requires no treatment, you should be evaluated for common causes of reactive thrombocytosis: 1
- Infection or inflammation (most common cause)
- Iron deficiency (check ferritin, iron studies)
- Tissue damage or recent surgery
- Malignancy (if other concerning symptoms present)
When to Consider Aspirin
Low-dose aspirin is not routinely recommended for asymptomatic mild thrombocytosis like yours. 1 Consider aspirin only if you develop microvascular symptoms such as:
- Burning pain in hands or feet (erythromelalgia)
- Visual disturbances
- Headaches or dizziness
Even then, aspirin should only be started after discussion with your physician. 1
Common Pitfalls to Avoid
- Do not pursue unnecessary treatment: The most important pitfall is treating mild thrombocytosis when no treatment is needed. Cytoreductive therapy carries risks and is never indicated at your platelet level. 1
- Do not automatically start antiplatelet therapy: Aspirin or other antiplatelet agents should not be prescribed based solely on a mildly elevated platelet count without other thrombotic risk factors. 1
- Do not worry about procedures: Your platelet count will not cause bleeding complications during dental work, minor procedures, or even major surgery. 1
Monitoring
- Single recheck in 4-8 weeks to confirm this is stable or resolving
- No ongoing monitoring needed if the count normalizes or remains stable in the mild range
- Investigate underlying causes as noted above, but the platelet count itself requires no specific follow-up
Bottom Line
Your platelet count of 389 × 10⁹/L is a benign finding that requires identification of the underlying cause but no treatment directed at the platelets themselves. 1, 2 Most cases of mild reactive thrombocytosis resolve once the underlying condition is addressed. 3 You can proceed with all normal activities and any planned procedures without concern. 1