Biopsy may explain climbing platelets

Dear Dr. Roach: My wife is 58 years old 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. The hematologist wants to prescribe blood thinners. 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. 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 your wife’s condition frustrating. You and your wife deserve to have the correct diagnosis and a thorough explanation of her treatment options.

By far, the most likely diagnosis is essential thrombosis. ET is a chronic myeloproliferative neoplasm, a type of blood cell cancer. Most people with this disease have a mutation in the blood cell causing the cells that make platelets to proliferate in the bone marrow. The bone marrow biopsy will show large numbers of megakaryocytes if she indeed has ET.

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.

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