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Secondary Thrombocythemia

(Reactive Thrombocytosis )

By Jane Liesveld, MD, Professor, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center
Patrick Reagan, MD, Fellow in Hematology and Medical Oncology, University of Rochester Medical Center

Secondary thrombocythemia is a disorder that causes production of excess platelets, leading to abnormal blood clotting or bleeding.

Production of excess platelets (thrombocythemia) can occur without any known cause (called essential or primary thrombocythemia). Thrombocythemia can also be caused by another disorder. When thrombocythemia is caused by such an underlying disorder, the thrombocythemia is called secondary thrombocythemia (or reactive thrombocytosis).

Causes of secondary thrombocythemia include

  • Bleeding

  • Removal of the spleen

  • Infections

  • Rheumatoid arthritis and other inflammatory disorders

  • Certain cancers

  • Premature destruction of red blood cells (hemolysis)

  • Iron deficiency

  • Certain blood disorders

  • Sarcoidosis

People with secondary thrombocythemia may have no symptoms related to the high number of platelets. Symptoms of the underlying condition usually dominate. When symptoms due to a high number of platelets do occur, they are similar to those of primary thrombocythemia. Symptoms include

  • Redness, warmth, and burning pain of the hands and feet

  • Tingling and other abnormal sensations in the fingertips, hands, and feet

  • Chest pain

  • Loss of vision or seeing spots

  • Headaches

  • Weakness

  • Dizziness

  • Bleeding, usually mild (such as nosebleeds, easy bruising, slight oozing from the gums, or bleeding in the digestive tract)

The spleen and liver may enlarge. Abnormal bleeding and clotting are usually not a concern with reactive or secondary platelet count elevations.

Secondary thrombocythemia is diagnosed—and distinguished from primary thrombocythemia—when people with high platelet counts have a condition that readily accounts for the high number of platelets. To identify possible causes, doctors do blood tests, sometimes including genetic testing, and occasionally a bone marrow biopsy. Other tests such as radiologic tests may be needed to ascertain the cause of the platelet elevation.

Treatment is aimed at the cause of the elevation. If the treatment is successful, the platelet count usually returns to normal.