Thrombocytos

is
Presented by
Ri

Platelet
Granule :
Glycoprotein
Thrombospondin
VEGF
PDGF
Angiogenesis

Dense granule :
Ca
Serotonin
ADP
Thromboxane A2
Aggregation

Platelet aggregation

Definition of
Thrombocytosis

Platelet count >

450,000/ml

Three Major
Causes ..
Familial thrombocytosis
Clonal thrombocytosis
Reactive
thrombocytosis

Familial
Thrombocytosis
Rare case reports
Hereditary
mutation of TPO gene
mutation of c-mpl receptor
Overproduction of
thrombopoitein

Clonal Thrombocytosis
Essential thrombocythemia
Polycythemia Vera
Chronic Myelocytic
Leukemia
Myelofibrosis with Myeloid
Metaplasia

Reactive Thrombocytosis
Infection
Malignancy
Autoimmune diseases
Postsplenectomy
Trauma
Rebound thrombocytosis
Anemia
Hemorrhage

Drug(Vincristine,steroid), etc

How to differentiate ?
Clonal

Reactive

myeloproliferative
dysregulation
malignant changes
thrombotic/hemorrhagic complication

secondary
responses
physiological
feedback
transient and
subsides
exceedingly rare/
Kawasaki disease

Reactive

Clonal
mpl

TPO

TPO
IL-6

Sensitivity
to TPO

IL-3

Mega

Mega
IL-11
GM-CSF

Prolifer

Proliferation
EPO

DiagnosisClonal
thrombocythemia
Blood Smear
Myelocyte
Metamyelocyte
Thrombocyte

Bone Marrow aspirate/biopsy

Giant megakaryocyte
Hypercellularity
Hyperplasia

Diagnosis

Clonal
thrombocythemia
Cytogenetic study
CML,Ph1,bcr-abl

Platelet aggregation test

ADP,Epinephrine

Complication
Clonal
Neurologic:
Headache
thrombocytemia
TIA

Thrombosis:
Coronary
Renal
Portal
DVT, Pul

Bleeding:
GI
Skin
Eye
Brain
Urinary tract

ComplicationClonal
thrombocytemia

Pregnancy:

Spontaneous abortion
IUGR

Others:
Erythromelalgia
Digital gangrence

Diagnosis

Reactive
Thrombocytosis

Rountine blood count

History
( URI,IDA,Surgery,Hemorrhage,Malignancy )
Elevated IL,APP,GM-CSF
ANA,RA
Anemia workup
Tumor marker

Complication Reactive
thrombocytosis
Underlying disease
Kawasaki disease: at risk of coronary
thrombosis or rupture

Treatment
Clonal

Reactive

Hydroxyurea
Anagrelide
IFN
Phosphorus-32
Low dose Aspirin

Treat underlying
No need unless
platelet >1,000,000
Aspirin for Kawasaki

BMT

Thrombocytosis
good or not good ?

Thrombocytosis and
cancer
Billroth :existence of cancer cells in association
with thrombus
Almost every step of the metastatic process linked
to platelet involvement
Association of thrombocytosis and poor prognosis
in stomach, colon, lung, kidney, and prostate
cancer
Limitation :negative association is rarely published

The Lancet Oncology, Volume3 Number 7 (July 2002)

Figure 4.Schematic diagram of a circulating tumor cell (blue) adhering

to the vascular endothelium (red) with the assistance of platelets (yellow)
in a small vessel. Activated platelets swell and adhere to tumor and
endothelial cells via integrins. After attachment of the tumor cell to the
endothelium, retraction of endothelial cells allows the tumor cell to move
out of the vessel (extravasation).

Thrombocytosis in
intensive care
A retrospective study
At least one platelet count > 450,000 (21.7%
of patients)
lower ICU mortality (p=0.003)
lower hospital mortality (p=0.006)
longer duration of ICU stay (p=0.0001)

Thrombocytosis, an independent predictor of

favorable outcome
Limitation :retrospective study, time course,
trauma hospital
British Journal of Anaesthesia, 87(6):926-8
(2001)

Time course of platelet

count in ICU
The prognostic value of a single platelet count is of little value
and maybe misleading
Late thrombocytopenia is more predictive of death than early
thrombocytopenia
A relative increase in platelet count after thrombocytopenia
was present only in survivors

Critical Care Medicine Volume 30 Number 4 (April 2002)

Figure 3. Daily platelet count in the 189

intensive care unit (ICU) survivors (unfilled
circles) and the 68 nonsurvivors (filled circles)
who stayed for at least 14 days in the ICU.

Does FOY (Gabaxate) induce

thrombocytosis ?

Does FOY (Gabaxate) induce

thrombocytosis ?
A case report
46 y/o woman, hemorrhagic tendency, ITP diagnosed
Foy (2000mg/day) for 4 days to prevent DIC
Platelet count:
Before treatment: 15,000
Day 4: 250,000
Day 7:28,000 due to discontinue
2nd FOY administration, transient increase again

Japanese Journal of Clinical Hematology

FOY and ITP

Another case report
47 y/o woman, subcutaneous hemorrhage,
hematemesis,
platelet: 1,000, ITP diagonosed
FOY (1500mg/day) infusion
platelet: 85,000, hematemesis disappeared
Discontinue, platelet: 1,000
The complement inhibitory action of Gabaxate
might have contribute to platelet increase

Thank you for your

attention !!

References
Thrombocytosis and thrombocythemia, Blood reviews(2001)15,159-166
A.I.Schafer
Sticky platelet syndrome and thrombocythemia, Hematology/oncology
Clinics of North America, Volume 17 Number 1 (February 2003) Eugene
P.Frenkel, Eberhard F.Mammen
Platelets and cancer, The Lancet Oncology, Volume3 Number 7 (July 2002)
GF Nask et al
Thrombocytosis in intensive care, British Journal of Anaesthesia, 87(6):926-8
(2001) A.M.Gurung et al
Time course of platelet counts in critical ill patients, Critical Care Medicine
Volume 30 Number 4 (April 2002) Sendar Akca et al
Gabaxate mesilate induced recovery from the thrombocytopenia in a patient
with acute ITP, Japanese Journal of Clinical Hematology, 37(7):624-9 (1996
Jul) Toyozumi H & Ikeda Y.
Gabaxate mesilate induced remarkable transient reversal of
thrombocytopenia in a ITP patient, Japanese Journal of Clinical Hematology,
32(3):227-30 (1991 Mar) Hashimoto M. et al