Significantly increased platelets

Platelets have the function of stopping bleeding after trauma and are an important component of blood. The number of platelets is in a state of dynamic equilibrium. Under the influence of certain factors, there will be a significant increase in platelets, and it is very likely to develop thrombocytosis. Although the incidence rate is not very high, it is very harmful. So, what is thrombocytosis? Let’s take a look below.

Clinical manifestations

The onset is slow and the clinical manifestations vary in severity. About 20% of patients, especially young people, have no symptoms at onset and are occasionally diagnosed through blood tests or the discovery of splenomegaly. In mild cases, there are only dizziness and fatigue; in severe cases, there may be bleeding and thrombosis. Bleeding is often spontaneous and may recur, occurring in about 2/3 of patients. Gastrointestinal bleeding is common, and there may also be epistaxis, gingival bleeding, hematuria, and ecchymosis of the skin and mucous membranes, but purpura is rare. The incidence of thrombosis is less than that of bleeding. According to domestic statistics, 30% of patients suffer from arterial or venous thrombosis. After limb vascular embolism, limb numbness, pain, and even gangrene may occur, and erythromelalgia may also occur. Thrombosis of the spleen and mesenteric vessels can cause abdominal pain and vomiting. Pulmonary, cerebral, and renal embolism cause corresponding clinical symptoms. Splenomegaly accounts for 80% and is generally mild to moderate. A few patients have hepatomegaly.

Treatment

Western medicine treatment

Although most experts believe that when the patient's platelet count exceeds 1X106/μl and there are bleeding or embolic complications should be treated. However, the indications for the treatment of essential thrombocythemia are still unclear. The goal of treatment is to reduce platelet count to normal or near normal to prevent thrombosis and bleeding.

① Myelosuppressive drugs

Busulfan is a commonly used and effective drug and should be used in small doses, starting at 4-6 mg/d. If a rapid decrease in platelets is required, hydroxyurea 2-4 g/d can be used, and then reduced to 1 g/d after 3-4 days. Cyclophosphamide, chlorambucil, melphalan, etc. are all effective. The medication can be stopped when the platelet count decreases or symptoms are relieved. If there is a relapse, the medication can be used again.

② Radionuclide phosphorus (32P) taken orally or intravenously

The first dose is 0.08-0.11MBq, and if necessary, another dose may be given three months later. It is generally not recommended because of the possibility of inducing leukemia.

③ Platelet separation

Rapidly reduce platelet count and improve symptoms. It is commonly used in gastrointestinal bleeding, pregnancy and delivery, and before elective surgery.

④Interferon

Interferon-alpha has recently been proposed as a treatment for essential thrombocythemia. It can inhibit megakaryocyte production and shorten platelet survival. The dosage is 3--5mu/d.