eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Thrombocytosis, Secondary

Author: Koyamangalath Krishnan, MD, FRCP, FACP, Paul Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine and Chief of Hematology-Oncology, Program Director, Hematology-Oncology Fellowship, James H Quillen College of Medicine at East Tennessee State University
Coauthor(s): Stephen J Smith, MD, Assistant Professor of Medicine, Department of Internal Medicine, Division of Hematology/Oncology, East Tennessee State University, James H. Quillen College of Medicine; Harsha G Vardhana, MD, Chief Fellow, Medical Oncology, Department of Internal Medicine, James H Quillen College of Medicine at East Tennessee State University
Contributor Information and Disclosures

Updated: Oct 4, 2009

Introduction

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

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 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).

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).9

Clinical

History

No unique symptoms are suggestive of secondary thrombocytosis (reactive thrombocytosis).

  • Most patients are asymptomatic and are identified on routine blood counts.
  • Patients may have symptoms that are referable to the primary condition that may have precipitated the secondary thrombocytosis (reactive thrombocytosis).

Physical

No distinguishing features of secondary thrombocytosis (reactive thrombocytosis) are found on physical examination.

  • Physical findings reflect the underlying condition.
  • In patients who have postsplenectomy thrombocytosis, evidence for a previous splenectomy should be evident on physical examination.10

Causes

  • Etiologic conditions associated with secondary thrombocytosis (reactive thrombocytosis) include the following:
    • Infection and inflammatory disorders
    • Postsplenectomy or hyposplenism
    • Malignancy
    • Trauma
    • Chronic inflammatory conditions
    • Hemorrhage, blood loss, or both
    • Iron-deficiency anemia
    • Rebound thrombocytosis
    • Asplenia (anatomic or functional)
    • Idiopathic

More on Thrombocytosis, Secondary

Overview: Thrombocytosis, Secondary
Differential Diagnoses & Workup: Thrombocytosis, Secondary
Treatment & Medication: Thrombocytosis, Secondary
Follow-up: Thrombocytosis, Secondary
References
Further Reading
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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. 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].

  10. 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].

  11. 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].

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

  13. 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].

  14. 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].

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

  16. 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].

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

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Keywords

secondary thrombocytosis, thrombocytosis, high platelet count, thrombocythemia, myeloproliferative disorders, reactive thrombocytosis, hemorrhagic thrombocythemia, bone marrow progenitor cells, pro-inflammatory cytokines, granulocyte colony-stimulating factor, G-CSF, granulocyte-macrophage colony-stimulating factor, GM-CSF, clonal thrombocytosis, platelet, interleukin, IL, IL-1, IL-6, IL-11, proinflammatory cytokines

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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, Program Director, Hematology-Oncology Fellowship, 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)

Stephen J Smith, MD, Assistant Professor of Medicine, Department of Internal Medicine, Division of Hematology/Oncology, East Tennessee State University, James H. Quillen College of Medicine
Stephen J Smith, MD is a member of the following medical societies: Alpha Omega Alpha and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Harsha G Vardhana, MD, Chief Fellow, Medical Oncology, Department of Internal Medicine, James H Quillen College of Medicine at East Tennessee State University
Harsha G Vardhana, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

CME Editor

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, 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 Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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