High Platelets: Causes, Symptoms, Diagnosis and Treatment

It is a condition in which the blood contains more platelets than usual.

Platelets are small fragments of blood cells that help the blood clot.

Possible complications of high platelets may include:

  • Bleeding
  • Blood clots.
  • Brain damage (like a stroke)

Usually, a healthy person’s average platelet count ranges from 150,000 to 450,000 platelets per microliter of blood (150-450 x 109 / L).

However, these limits are determined by the lower and upper 2.5th percentile, and a deviation does not necessarily imply any form of the disease.

However, it is considered that more than 750,000 (and significantly more than one million) are severe enough to warrant investigation and intervention. A high platelet count can be identified by routine blood testing.

The appearance of high platelets is divided into two medical categories: primary thrombocythemia and secondary thrombocytosis.


In primary thrombocythemia, the cause of high platelets is unknown and occurs as an independent condition.

In secondary thrombocytosis: high platelets occur as a symptom of another disease or condition, such as anemia, infection, or cancer.

In many cases, high platelets may not produce specific symptoms. In other cases, the elevation of platelet levels leads to unwanted and unnecessary blood clots throughout the body, producing a series of symptoms.

The presence of high platelets is rarely associated with a medical emergency. However, high platelets can cause blood clots, hemorrhages, or strokes in some cases.

Seek immediate medical attention if high platelets are accompanied by a persistent headache, difficulty breathing, dizziness, seizures, changes in speech or confusion, or loss of consciousness for a brief moment.

If your high platelet condition is persistent or worrisome, seek immediate medical attention.

What causes high platelets?

Platelets are made in the bone marrow, the tissue located inside the bones. Abnormally high platelet production can occur independently for reasons that are not known (primary thrombocythemia) or as a symptom of another condition (secondary thrombocytosis).

Thrombocytosis (or thrombocythemia) is the presence of high platelet counts in the blood. It may be primary (also called essential and caused by a myeloproliferative disease) or reactive (also called secondary).

Although it is often asymptomatic (mainly when a secondary reaction), it may predispose to thrombosis in some patients. Thrombocytosis can be contrasted with thrombocytopenia, a loss of platelets in the blood.

Some causes of high platelet counts are spleen removal, infections, cancer, and rheumatoid arthritis.

The increase in platelet counts can be due to a series of disease processes:

  • Myeloproliferative disease
  • Other myeloproliferative disorders include chronic myelogenous leukemia, polycythemia vera, and myelofibrosis.
  • Inflammation.
  • Surgery (which leads to an inflammatory state)
  • Hypoplenism (decreased decomposition due to decreased function of the spleen).
  • Asplenia (absence of normal function of the spleen).
  • Anemia due to iron deficiency or hemorrhage.

Overmedication with medications that treat thrombocytopenia, such as eltrombopag or romiplostim, can also cause thrombocytosis. Other causes include the following:

  • Kawasaki disease
  • Soft tissue sarcoma
  • Osteosarcoma.
  • Dermatitis (rarely)
  • Inflammatory bowel disease
  • Rheumatoid arthritis.
  • Nephritis.
  • Nephrotic syndrome.
  • Bacterial diseases include pneumoniasepsis, meningitis, urinary tract infections, and septic arthritis.

Most of the causes of thrombocytosis are acquired disorders, but they can be congenital in some cases, such as thrombocytosis due to congenital asplenia.

Spleen removal:

Splenectomy, or splenectomy, is associated with elevated platelet counts throughout life. The spleen helps eliminate excess platelets from the bloodstream.

An increase in platelet count can also be caused by inadequate spleen functioning. Low doses of aspirin are recommended to help prevent bleeding or episodes of blood clotting.


A high platelet count often accompanies an infection. This usually occurs due to hormones called cytokines produced as part of the body’s legal defense against infection.

Thrombocytosis due to infection is more common in children than in adults. Thrombocytosis usually resolves as the patient recovers from the infection, although it may take longer to establish.


Cancer can cause damage to healthy tissues in the body, resulting in increased blood loss. This stimulates the bone marrow to produce more blood cells, increasing platelet production.

A standard blood test may help diagnose cancer earlier, according to research that suggests a high platelet count is strongly associated with the disease.

The researchers say that elevated platelet counts are a good predictor of cancer, as is a breast lump for breast cancer.

This is a clue that GPs can use to help select patients for further investigation; some patients may not have other cancer symptoms to achieve an earlier diagnosis.

Previous studies have suggested a link between thrombocytosis and various cancers, indicating that high platelet counts may signify cancer of the esophagus, stomach, lung, or uterus.

For approximately one-third of lung and colorectal cancer cases in patients with thrombocytosis, no other symptoms raised the suggestion of cancer.

This makes testing for elevated platelet counts a valuable tool and could accelerate cancer diagnosis for at least three months for thousands of patients a year.

Rheumatoid arthritis:

An increase in platelet count often accompanies rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disorder with inflammation of the joints. This inflammation can cause an overproduction of platelets.

Neoplasias mieloproliferativas:

Essential or primary thrombocytosis can be caused by myeloproliferative diseases or myeloproliferative neoplasms (myeloproliferative neoplasms), a group of blood cancers that affect the bone marrow.

The paramount polycythemia vera, primary myelofibrosis, and essential thrombocytopenia can progress to more severe conditions like myelodysplastic syndrome and acute myeloid leukemia.

Myeloproliferative neoplasms can affect adults and children. According to the Myeloproliferative Neoplasm Foundation, these incurable diseases affect approximately 176,000 people in the United States.

Chronic inflammatory diseases:

Thrombocytosis can be part of the clinical picture of rheumatoid arthritis and inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis.

Elevated platelets are one of the many abnormal laboratory findings expected in celiac disease, characterized by an inflammatory reaction to gluten in the diet that damages the small intestine.

Gluten is a protein found in wheat, barley, and rye. Strictly avoiding gluten foods can completely resolve the symptoms and is the only treatment for celiac disease.

A 2002 ” American Family Physician ” report reports that gluten intolerance can affect one in 250 people, predominantly those of European origin.


Excessive use of medications in treating low platelet counts can cause high platelets in the blood.

Thrombocytosis can also be an uncommon side effect of antibiotics containing cephalosporin or amoxicillin, such as Cefizox or Augmentin, and the combination of piperacillin and tazobactam in Zosyn, which is used intravenously to treat serious infections.

Iron deficiency anemia:

The elevated platelet count is not uncommon in patients with sideropenic anemia, specifically iron deficiency anemia.

Sometimes, the platelet count may be greater than 1000 × 109 / L. The introduction of iron replacement therapy helps the platelet count usually return to normal within ten days.

Agnogenic myeloid metaplasia:

Also known as idiopathic myelofibrosis, agnogenic myeloid metaplasia manifests through anemia and splenomegaly.

A peripheral blood smear review often detects leukocytoblastosis, described as a finding of erythrocytes in the form of tears and immature precursors of red blood cells and leukocytes.

Thrombocytosis has been found in approximately 33% of patients with this disease, but thrombocytopenia is usually the significant finding in the advanced stages of the disease.

For most myelodysplastic disorders, thrombocytosis is not typical. 

It is often a normal or reduced platelet count sample in most patients.

A form of myelodysplastic syndrome, called “5q syndrome,” is associated with thrombocytosis in 50% of patients.

Signs and symptoms

High platelet levels do not indicate any clinical problem and are detected with a routine complete blood count.

However, a complete medical history must be obtained to ensure that the increase in platelet count is not due to a secondary process.

It often occurs with an inflammatory disease since platelet production’s powerful stimulants (e.g., thrombopoietin) are elevated in these clinical conditions as part of the acute phase reaction.

The high platelet count can occur in patients with polycythemia vera (high red blood cell counts) and is an additional risk factor for complications.

A tiny segment of patients reports symptoms of erythromelalgia, burning sensation, and redness of the extremities that resolves with the cooling and use of aspirin.

The scientific literature sometimes excludes thrombocytosis from the scope of thrombophilia by definition. However, in practice, by the definition of thrombophilia as a greater predisposition to thrombosis, thrombocytosis (mainly primary thrombocytosis) is a possible cause.

In contrast, secondary thrombocytosis rarely causes thrombotic complications.

The generalized symptoms that can occur with high platelets include:

Abnormal sensations:

Too many platelets in the bloodstream can cause the formation of blood clots in small and large blood vessels anywhere in the body.

A blood clot partially blocks a vessel and can interfere with the amount of blood and oxygen that reaches the body tissues.

As a result, you may experience tingling, numbness, or other abnormal sensations in your hands and feet called paresthesias.

You may also notice that your hands, fingers, feet, or toes feel unusually cold to the touch. Deteriorated blood flow can also affect your blood pressure, causing you to feel dizzy or weak.

Blood clots in the small eye vessels or large clots in the larger vessels of the body can damage vision, causing blurred vision or other visual disturbances.

Due to high platelet counts, persistent headaches and chest pain can also indicate abnormal coagulation.


Excess platelet count associated with thrombocythemia or primary thrombocytosis can also cause hemorrhage. This bleeding is usually mild and commonly results in nosebleeds, oozing of the gums, or bleeding in the stomach or digestive tract.

You may also bruise easily or notice unexplained bruises on the skin. Bloody stools, bleeding from the airways, or prolonged bleeding after surgical procedures or tooth extraction.

Some people may also develop ulcers on the fingers or toes.

High platelets can accompany other symptoms, depending on the disease, disorder, or underlying condition. However, some people with high platelets may not experience any other symptoms.

Routine blood tests in these individuals can only detect high platelets.

People with primary thrombocythemia have a higher risk of bleeding and blood clots than those with secondary thrombocytosis.

Symptoms of bleeding that may occur along with high platelets:

Symptoms of abnormal bleeding include:

  • She was bleeding in the mouth or gums.
  • Stools with blood (blood can be red, black, or tarred).
  • Easy bruising or bleeding
  • Nasal hemorrhages.

Symptoms of blood clotting that may occur together with high platelets:

The extremities and the brain are common sites for the formation of blood clots with high platelets. Clots can also form in other organs.

Blood clots in the placenta often cause pregnancy loss in pregnant women with primary thrombocythemia.

Signs and symptoms of blood clotting, which can be severe or even life-threatening, may include:

  • Changes in speech.
  • Confusion or loss of consciousness even for a brief moment.
  • Difficult breathing
  • Dizziness.
  • Intense burning and throbbing pain in arms or legs.
  • Nausea.
  • Pain in the jaw, abdomen, or neck.
  • Convulsions

Severe symptoms that can indicate a life-threatening condition:

In some cases, high platelets can accompany the symptoms of blood clotting, which can cause a life-threatening condition that must be evaluated immediately in an emergency setting.

If blood clots form and completely block blood flow through a blood vessel, or if they detach from a blood vessel and travel to the heart, lungs, or brain, they can cause life-threatening symptoms of a stroke or stroke. Cardiac.

Enlargement of the spleen and liver and severe hemorrhage from bleeding that can not be stopped can also occur.

Some people may develop primary myelofibrosis, a disorder that occurs due to the healing of the bone marrow.

Primary myelofibrosis causes blood to form in the liver or spleen, resulting in abdominal swelling due to swelling of the internal organs.

Seek immediate medical attention (call emergency) if you, or someone you are with, have any of these life-threatening symptoms, including:

  • Confusion or loss of consciousness even for a brief moment.
  • Difficult breathing
  • Dizziness
  • Persistent headaches
  • Convulsions
  • Shortness of breath
  • Difficulty speaking.

Primary thrombocythemia:

Thrombocythemia is a condition in which high platelets occur as an independent condition with no other known cause. In this condition, the bone marrow produces too many platelets. This condition can be inherited.

Secondary thrombocytosis:

Thrombocytosis is the appearance of high platelets as a symptom of another condition. A wide range of diseases and conditions can cause high platelets, which include:

  • Anemia (low red blood cell count).
  • Loss of blood.
  • Cancer.
  • Chemotherapy.
  • Chronic myeloid leukemia (a type of cancer that develops in the bone marrow, the soft tissue inside the bones that helps form blood cells).
  • Infection.
  • Inflammatory disorders such as Kawasaki disease (a rare childhood disease that involves inflammation of blood vessels).
  • Myelodysplasia (group of conditions in which blood cells are abnormal in development or function).
  • Myelofibrosis (a disorder that produces scar tissue in the bone marrow).
  • Polycythemia vera (a rare disorder of the bone marrow that causes excessive production of blood cells).
  • Reaction to certain medications, including steroids.
  • Splenectomy (surgical removal of the spleen).


Laboratory tests may include complete blood count, liver enzymes, renal function, and erythrocyte sedimentation rate.

If the cause of the high platelet count remains unclear, a bone marrow biopsy is often performed to differentiate whether the high platelet count is reactive or essential.

Questions to diagnose the cause of high platelets:

To diagnose your condition, your doctor or authorized health care professional will ask you several questions related to your high platelets, including:

  • Are you experiencing other symptoms, such as weakness or bleeding?
  • What medications are you taking?
  • Have you been diagnosed with any other condition?
  • What are the possible complications of high platelets?

Because high platelets can be due to severe illnesses, failure to seek treatment can result in severe complications and permanent damage.

Once the underlying cause is diagnosed, you must follow the treatment plan that you and your healthcare provider explicitly designed so that you can reduce the risk of possible complications.


Often, treatment for reactive thrombocytosis is not required or necessary. In cases of reactive thrombocytosis of more than 1,000 × 109 / L, a low daily dose of aspirin (such as 65 mg) may be considered to minimize the risk of stroke or thrombosis.

However, in primary thrombocytosis, if the platelet count exceeds 750,000 or 1,000,000, especially if there are other risk factors for thrombosis, treatment may be needed.

The selective use of aspirin in low doses is considered protective. In primary thrombocytosis, extremely high platelet counts can be treated with hydroxyurea (a cytoreductive agent) or anagrelide (Agrylin).

In the favorable disorders of Jak-2, ruxolitinib (Jakafi) can be effective.