To Your Good Health: Climbing platelet count deserves reasonable diagnosis

BY KEITH ROACH, M.D.

DEAR DR. ROACH: My wife is 58 years old, in good health, exercises and gets regular checkups. The bloodwork from those checkups has shown that her platelet count was 400 a year ago, 600 six months ago and 800 a couple weeks ago. She went to a hematologist who had little more information than her internist on why it’s happening, stating it was “blood tumors.”

My wife has no other symptoms like bruising, bleeding, headaches, tiredness or vision issues. Her blood pressure is within the normal range. The hematologist wants to prescribe blood. The next step will be a bone marrow biopsy. The only thing she takes now is vitamins, and she will add a baby aspirin to her daily routine. The only changes to her lifestyle in the past year have been an increase in weight gain, but she is not overweight, and an increase in alcohol consumption. Both factors are a result of us being empty nesters and doing a lot more entertaining and traveling.

What are the causes of platelet counts dramatically increasing like that? Are there effective ways besides blood thinners to reduce or control the platelet production? — Anon.

ANSWER: I find the treatment of (and communication about) your wife’s condition frustrating (I’m being kind). You and your wife deserve to have the correct diagnosis and a thorough explanation of her treatment options. I hope she will hear more once the bone marrow biopsy is back.

By far, the most likely diagnosis is essential thrombosis (“essential” in this context means we don’t know what causes it; the “thrombosis” means “too many blood-clotting cells,” otherwise known as platelets). ET is a chronic myeloproliferative neoplasm, a type of blood cell cancer. Most people with this disease have a mutation in the blood cell (an acquired mutation, one not present at birth) causing the cells that make platelets (called megakaryocytes) to proliferate in the bone marrow. The bone marrow biopsy will show large numbers of megakaryocytes if she indeed has ET. She will also be tested for the JAK2 mutation since that has important information to help predict the course of her disease.

Treatment for symptoms is not appropriate if she has no symptoms. The goals of treatment are to prevent complications of this disease (abnormal clotting is the major concern: bleeding is less common) and to be alert for transformation to a more aggressive disease, acute myelogenous leukemia.

There is no treatment known to cure this disease nor prevent its transformation to leukemia. However, most people with this disease do not have a shortening of their life expectancy.

The aspirin she was given was to reduce clot risk. If she turns out to be higher risk, she may be offered additional therapy, such as hydroxyurea, to reduce the number of clotting cells and further reduce clotting risk. Since hydroxyurea has a potential for side effects, it is given only if the benefits outweigh the risks. I’d like to hear back from you after the biopsy.

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