Secondary Thrombocytosis 

  • Author: Koyamangalath Krishnan, MD, FRCP, FACP; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Jan 10, 2012
 

Background

Platelets are acute-phase reactants; therefore, they increase in response to various stimuli, including systemic infections, inflammatory conditions, bleeding, and tumors.[1, 2, 3] This is called reactive or secondary thrombocytosis, which is a benign form of thrombocytosis. Clonal thrombocytosis (primary or essential thrombocytosis) is an unregulated abnormality of platelet production due to a clonal expansion of bone marrow progenitor cells.[4, 5]

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Pathophysiology

Secondary thrombocytosis (reactive thrombocytosis) may be due to the overproduction of proinflammatory cytokines, such as interleukin (IL)-1, IL-6, and IL-11, that occurs in chronic inflammatory, infective, and malignant states.[6, 7, 8, 9] The presence of elevated IL-1, IL-6, C-reactive protein (CRP), granulocyte colony-stimulating factor (G-CSF), and granulocyte-macrophage colony-stimulating factor (GM-CSF) in individuals with these conditions suggests that these cytokines may be involved in secondary thrombocytosis (reactive thrombocytosis).

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Epidemiology

Frequency

United States

Secondary thrombocytosis (reactive thrombocytosis) is a relatively common condition. In a series from a large university hospital that included 280 patients with extreme thrombocytosis, 82% had Secondary thrombocytosis (reactive thrombocytosis), which is more common than clonal thrombocytosis (primary or essential thrombocytosis).

International

Secondary thrombocytosis (reactive thrombocytosis) is common in worldwide.

Mortality/Morbidity

Secondary thrombocytosis (reactive thrombocytosis) is generally considered a benign condition. Extremely high platelet elevations may require treatment as a means of minimizing unusual vascular complications.

Race

No race predilection exists for secondary thrombocytosis (reactive thrombocytosis).

Sex

No sex predilection exists for secondary thrombocytosis (reactive thrombocytosis), except that iron deficiency is more prevalent in females during childbearing years.

Age

No age predilection exists for secondary thrombocytosis (reactive thrombocytosis).[10, 11]

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Contributor Information and Disclosures
Author

Koyamangalath Krishnan, MD, FRCP, FACP  Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, and Royal College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Devapiran Jaishankar, MBBS  Fellow, Division of Oncology, East Tennessee State University, James H Quillen College of Medicine

Devapiran Jaishankar, MBBS is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Clinical Oncology, and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Wadie F Bahou, MD  Chief, Division of Hematology, Hematology/Oncology Fellowship Director, Professor, Department of Internal Medicine, State University of New York at Stony Brook

Wadie F Bahou, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marcel E Conrad, MD  Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group

Disclosure: No financial interests None None

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

References

  1. Vora AJ, Lilleyman JS. Secondary thrombocytosis. Arch Dis Child. Jan 1993;68(1):88-90. [Medline]. [Full Text].

  2. Mantadakis E, Tsalkidis A, Chatzimichael A. Thrombocytosis in childhood. Indian Pediatr. Aug 2008;45(8):669-77. [Medline].

  3. Mata Fernández C, Pérez-Miranda Castillo J, Galarón García P, Cela de Julián E, Beléndez Bieler C. [Thrombocytosis in the oncology-haematology clinic: description, aetiological diagnosis and progression thrombocytosis] [Spanish]. An Pediatr (Barc). Jul 2008;69(1):10-4. [Medline]. [Full Text].

  4. Hoffman R. Primary thrombocythemia. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hematology: Basic Principles and Practice. 3rd ed. Philadelphia, Pa: Churchill Livingstone; 2000:1188-204.

  5. Hellmann A. Myeloproliferative syndromes: diagnosis and therapeutic options. Pol Arch Med Wewn. Dec 2008;118(12):756-60. [Medline].

  6. Tefferi A, Ho TC, Ahmann GJ, Katzmann JA, Greipp PR. Plasma interleukin-6 and C-reactive protein levels in reactive versus clonal thrombocytosis. Am J Med. Oct 1994;97(4):374-8. [Medline].

  7. Kutti J, Wadenvik H. Diagnostic and differential criteria of essential thrombocythemia and reactive thrombocytosis. Leuk Lymphoma. Sep 1996;22 suppl 1:41-5. [Medline].

  8. Araneda M, Krishnan V, Hall K, et al. Reactive and clonal thrombocytosis: proinflammatory and hematopoietic cytokines and acute phase proteins. South Med J. Apr 2001;94(4):417-20. [Medline].

  9. Haidopoulou K, Goutaki M, Lemonaki M, Kavga M, Papa A. Reactive thrombocytosis in children with viral respiratory tract infections. Minerva Pediatr. Aug 2011;63(4):257-62. [Medline].

  10. Indolfi G, Catania P, Bartolini E, et al. Incidence and clinical significance of reactive thrombocytosis in children aged 1 to 24 months, hospitalized for community-acquired infections. Platelets. Sep 2008;19(6):409-14. [Medline].

  11. Chiarello P, Magnolia M, Rubino M, Liguori SA, Miniero R. Thrombocytosis in children. Minerva Pediatr. Dec 2011;63(6):507-13. [Medline].

  12. Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Postsplenectomy reactive thrombocytosis. Proc (Bayl Univ Med Cent). Jan 2009;22(1):9-12. [Medline].

  13. Tsantes AE, Dimoula A, Bonovas S, Mantzios G, Tsirigotis P, Zoi K, et al. The role of the Platelet Function Analyzer (PFA)-100 and platelet aggregometry in the differentiation of essential thrombocythemia from reactive thrombocytosis. Thromb Res. Aug 5 2009;[Medline].

  14. Dame C, Sutor AH. Primary and secondary thrombocytosis in childhood. Br J Haematol. Apr 2005;129(2):165-77. [Medline].

  15. Birdane A, Haznedaroglu IC, Bavbek N, et al. The plasma levels of prostanoids and plasminogen activator inhibitor-1 in primary and secondary thrombocytosis. Clin Appl Thromb Hemost. Apr 2005;11(2):197-201. [Medline].

  16. Chanet V, Tournilhac O, Dieu-Bellamy V, et al. Isolated spleen agenesis: a rare cause of thrombocytosis mimicking essential thrombocythemia. Haematologica. Nov 2000;85(11):1211-3. [Medline]. [Full Text].

  17. Frye JL, Thompson DF. Drug-induced thrombocytosis. J Clin Pharm Ther. Feb 1993;18(1):45-8. [Medline].

  18. Messinezy M, Westwood N, Sawyer B, et al. Primary thrombocythaemia: a composite approach to diagnosis. Clin Lab Haematol. Jun 1994;16(2):139-48. [Medline].

  19. Pearson TC. Diagnosis and classification of erythrocytoses and thrombocytoses. Baillieres Clin Haematol. Dec 1998;11(4):695-720. [Medline].

 
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