Mr. Zhang is a 30-year-old white-collar worker. He has always felt headaches and fatigue at work recently. Seeing this, his colleagues enthusiastically gave him various suggestions, “You are suffering from sha. Come on, come on, I’ll help you get a shave.” The doctor suggested that Xiaoming get a blood test, it might be thrombocytosis.
Platelets are blood cells in our body whose main function is to help stop bleeding. Platelets in the peripheral blood of normal people are 100-300×10^9/L, and more than 450×10^9/L are called thrombocytosis. Since platelets can help us stop bleeding, what’s wrong with having more?
That’s because, in our human body’s circulation, we pay attention to balance. Anything is not good if it is less, and it will be bad if there is too much. The harm of thrombocytosis is to increase the incidence of thrombosis, including arterial thrombosis and venous thrombosis, and some patients have headache, visual symptoms, and erythematous limb pain due to microvascular thrombosis. A small number of patients have bleeding symptoms, including gastrointestinal bleeding, epistaxis, bleeding gums, and hematuria. 50%-80% of patients have splenomegaly, mostly moderate, and splenomegaly is rare.
In the first examination, Mr. Zhang’s blood routine showed that the platelets were 1160×10^9/L, and the doctor suggested hospitalization.
There are many reasons for thrombocytosis, which are mainly divided into three types: reactive, spontaneous and primary.
Reactive thrombocytosis is common in infections, after surgery, malignancy, after splenectomy, acute blood loss or iron deficiency, trauma, noninfectious inflammation, etc. Increased release of progenin, interleukin-6), leading to thrombocytosis.
Spontaneous thrombocytosis is common in myeloproliferative diseases, such as polycythemia vera, early myelofibrosis, and chronic myeloid leukemia.
The pathogenesis of essential thrombocythemia may be related to the changes of thrombopoietin and thrombopoietin receptors and the activation of downstream pathways.
At present, the most commonly used method for thrombocytosis is to actively control and treat the primary disease, reduce the number of platelets, prevent thrombosis and bleeding, and reduce disease progression.
Mr. Zhang belongs to the high-risk group of thrombosis. The doctor adopts cytoreduction therapy, that is, using a blood cell separator to remove platelets to reduce the cells to a lower level, and then use hydroxyurea for disease control. Now, Mr. Zhang has been successfully discharged from the hospital, and the platelets are also controlled at normal levels.
Author: Chen Linxia (Hematologist, Fengxian District Central Hospital, Shanghai)
Editor: Li Chenyan
Editor in charge: Tang Wenjia