Thrombocytosis Definition, Reason, Symptoms, Treatment & Prevention
Thrombocytosis Definition
Thrombocytosis is a condition where there are too many platelets (platelets) circulating in the blood. The normal value of platelet levels in each laboratory varies, depending on the examination tool used. However, most laboratories use a normal value of 150,000-450,000 ul(microliter).
Platelets are a component of blood that is produced by the bone marrow and released into the blood circulation, which functions to clot blood in case of bleeding. However, if the amount is excessive, as occurs in thrombocytosis, then the blood clotting process will occur excessively.
Based on the cause, thrombocytosis is divided into two, namely:
- Essential thrombocytosis (also called essential thrombocythemia), which is a condition where there are too many platelets in the blood due to hyperactivity of the bone marrow in producing platelets.
- Secondary thrombocytosis (or also known as reactive thrombocytosis), which is a condition where there are too many platelets in the blood as the body’s reaction to another disease, such as an infection.
In this article, the thrombocytosis that will be discussed is essential thrombocytosis. This disease is more common in people aged 60 years and over, and rarely in children. Essential thrombocytosis can be dangerous because the resulting blood clot can block blood vessels (thrombosis) in various organs.
Thrombocytosis Symptoms
Essential thrombocytosis causes sufferers’ blood to clot more easily than healthy people. This causes blood clots to form in various places in the body. Therefore, the symptoms of essential thrombocytosis occur due to blockage of the blood vessel by a blood clot.
One of the locations of the blood vessels that are often clogged due to this disease is the blood vessels at the fingertips. This results in a painful or burning sensation in the fingertips. If not treated immediately, the fingertips can experience injuries and gangrene due to blocked blood flow.
In addition, symptoms that also often appear are neurological symptoms in the form of headaches, and symptoms such as stroke in the form of slurred speech, dizziness, blurred vision, seizures, fainting, and so on.
Not only thrombotic symptoms, essential thrombocytosis can also cause bleeding symptoms. This condition most often occurs in the digestive tract, characterized by severe abdominal pain, vomiting blood, or loose and blackish bowel movements. In addition, bleeding can also occur in the gums, skin, urinary tract, or in the brain.
If essential thrombocytosis is experienced by pregnant women, pregnancy complications such as miscarriage, stunted fetal growth, and intrauterine fetal death (IUFD) can also occur.
However, not all patients with essential thrombocytosis feel any symptoms. Studies find that in about 25-30 percent of sufferers, there are no symptoms whatsoever. The disease was only discovered when he did laboratory tests.
In 1-5 percent of patients with essential thrombocytosis, it is found that the disease develops into acute myeloid leukemia (AML), which is characterized by fever, easy infection, easy bleeding, and very many young leukocytes found on blood tests.
The condition of essential thrombocytosis is susceptible to turning into AML in patients aged 50 years and over, have a platelet count above 1,000,000 ul(microliter), and some of their genes have mutations.
Thrombocytosis Reason
Essential thrombocytosis occurs because the bone marrow is hyperactive in producing platelets. However, until now, the cause of bone marrow hyperactivity is not clearly known.
However, several studies have found that in the majority of patients with essential thrombocytosis, mutations in the Janus Kinase 2 (JAK2), calreticulin (CALR) or myeloproliferative leukemia virus oncogene (MPL) genes are found.
Diagnosis
Doctors will generally think of essential thrombocytosis if they find blood tests showing high levels of platelets. The doctor will also conduct interviews and physical examinations regarding the symptoms that are often caused by thrombocytosis.
In addition to blood tests, other tests that are generally performed are bone marrow aspiration and biopsy, as well as genetic testing to determine whether there is a gene mutation that often causes thrombocytosis.
The diagnosis of essential thrombocytosis can be confirmed if four of the following are found on examination:
- The platelet count is always above 450,000 ul(microliter) on several examinations.
- Enlarged megakaryocytes (platelet-forming cells in the bone marrow) are found on bone marrow aspiration or biopsy examination.
- An enlarged spleen that is known from a physical examination or abdominal ultrasonography (USG).
- Presence of clinical signs of thrombosis or recurrent bleeding.
Thrombocytosis Treatment
Treatment of essential thrombocytosis varies, depending on the condition of the sufferer. Treatment is generally given to patients with the following conditions:
- Age 60 and over
- Have a history of thrombosis
- Have platelet levels above 1.5 million/ul
- Obesity
- Have a disease that is at risk of causing a heart attack such as hypertension, high cholesterol, or have a smoking habit
- Have an immune disorder that causes blood clots, such as antiphospholipid syndrome
- Has a JAK2 gene mutation
If a patient with essential thrombocytosis has one of the conditions above, generally treatment with low-dose aspirin will be given to prevent the blood from clotting too easily. Aspirin is taken for life.
In cases of severe thrombocytosis, thrombopoiesis will also be performed to reduce the number of platelets in the blood. Thrombopheresis ( plateletpheresis ) is a procedure similar to hemodialysis, performed by connecting blood vessels with a machine. The blood will be flowed into the apheresis machine, the platelets will be taken by the machine, then the rest of the other blood components are put back into the body.
In addition to thrombopoiesis, to reduce the number of platelets, patients can also be given cytoreducing drugs such as hydroxyurea, busulfan, anagrelide, or interferon.
Meanwhile, people with thrombocytosis who do not experience the special conditions above, are generally only monitored periodically by a doctor, without being given any medication. However, a healthy lifestyle such as maintaining an ideal body weight, managing your diet, and exercising regularly is mandatory to prevent complications of thrombocytosis.
Prevention
Until now, there has been no action to prevent the occurrence of essential thrombocytosis. However, living a healthy lifestyle can help prevent complications in patients with essential thrombocytosis.