eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Thrombocytosis, Secondary: Treatment & Medication

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

Treatment

Medical Care

  • The primary treatment of secondary thrombocytosis (reactive thrombocytosis) should address the underlying cause of the thrombocytosis. In general, no treatment is indicated to directly reduce the platelet count.11
  • For patients with platelet counts in excess of 1,000,000/μL, aspirin 65 mg daily may be considered to minimize the rare development of stroke or thrombosis.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications in cases of secondary thrombocytosis (reactive thrombocytosis).

Antiplatelet Agents

Antiplatelet agents inhibit platelet function by inhibition of the platelet cyclooxygenase system.


Aspirin (Anacin, Ascriptin, Bayer Aspirin)

Irreversibly acetylates (and inactivates) platelet and endothelial cell cyclooxygenase. A lower dose (65 mg) preferentially inhibits the platelet cyclooxygenase system (responsible for thromboxane A2 production) while preserving the beneficial effects of endothelial cell prostacyclin production due to difference in sensitivity to the inhibition by aspirin of cyclooxygenases at different sites and due to turnover of the endothelial cell cyclooxygenases.

Adult

65-325 mg PO qd

Pediatric

65 mg PO qd

Effects may decrease with antacids and urinary alkalinizers; corticosteroids decrease the salicylate serum levels; additive hypoprothrombinemic effects and increased bleeding time may occur with the coadministration of anticoagulants; may antagonize the uricosuric effects of probenecid and increase the toxicity of phenytoin and valproic acid; doses >2 g/d may potentiate the glucose-lowering effect of sulfonylurea drugs

Documented hypersensitivity; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma; because of the association of aspirin with Reye syndrome, do not use in children (<16 y) with flu

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

May cause a transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, with a history of blood coagulation defects, or who are taking anticoagulants; although aspirin is considered unsafe in pregnancy, some pregnancy-related conditions exist in which aspirin may be involved (eg, preeclampsia, antiphospholipid antibody syndrome)

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 Clinical Oncology, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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