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Correlation of Thrombosis With Increased Platelet Turnover in
Thrombocytosis
Henry M. Rinder,
Judith E. Schuster,
Christine S. Rinder,
Chao Wang,
Helen J. Schweidler, and
Brian R. Smith
From the Department of Laboratory Medicine, Yale University School of
Medicine, New Haven, CT.
There are no readily applicable methods to routinely assess
thrombosis risk and treatment response in thrombocytosis. Reticulated platelets (RP) define the most recently released platelets in the
circulation, and the RP% has been shown to estimate platelet turnover
in thrombocytopenic states. We examined whether increased RP values
were associated with thrombotic complications in thrombocytosis. Platelet count, RP%, and absolute RP count were measured at
presentation in 83 patients with chronic or transient thrombocytosis,
46 patients with deep vein (DVT) or arterial (ART) thrombosis and
normal platelet counts, and 83 healthy controls with normal platelet
counts. Chronic thrombocytosis patients presenting with thrombosis (n
= 14) had significantly higher RP% (14.7% ± 10.1%, mean ± SD)
than asymptomatic chronic thrombocytosis patients (n = 23, RP%
= 3.4% ± 1.8%), healthy controls (3.4% ± 1.3%), DVT
patients (n = 21, 3.8% ± 2.1%), or ART patients (n = 25, 4.5% ± 4.1%, P < .05 for all comparisons). Chronic thrombocytosis patients with thrombosis also had significantly higher absolute RP counts than asymptomatic chronic thrombocytosis patients (98 ± 64 × 109/L [range, 54 to 249 × 109/L] v 30 ± 13 × 109/L
[range, 11 to 51 × 109/L]; P = .0004),
whereas healthy controls, DVT, and ART patients had similarly low
absolute RP counts (6 ± 6 × 109/L, 9 ± 7 × 109/L, and 11 ± 7 × 109/L,
respectively; P > .49). The RP% and absolute RP counts
remained significantly higher in chronic thrombocytosis patients with
thrombosis when patients were further subdivided into primary
myeloproliferative disorders versus secondary thrombocytosis. Similarly
elevated RP percentages and absolute counts were also noted in
transient thrombocytosis patients with thrombosis (n = 6, 11.5% ± 4.4% and 90 ± 46 × 109/L, respectively) when compared
with asymptomatic transient thrombocytosis patients (n = 40, 4.5% ± 2.7% and 35 ± 16 × 109/L, respectively) and to all
control groups (P < .05 for all comparisons). In
addition, 7 of 8 thrombocytosis patients who were studied before developing symptoms of thrombosis had elevated absolute RP counts compared with only 1 of 63 thrombocytosis patients who remained asymptomatic. Follow-up studies in seven chronic thrombocytosis patients showed that successful aspirin treatment of symptomatic recurrent thrombosis significantly reduced the RP% from 17.1% ± 10.9% before therapy to 4.8% ± 2.0% after therapy; absolute RP
counts decreased from 102 ± 67 × 109/L to 26 ± 10 × 109/L (P < .01 for both). We conclude that
thrombosis in the setting of an elevated platelet count is associated
with increased platelet turnover, which is reversed by aspirin therapy.
Measurement of reticulated platelets to assess platelet turnover may be
useful in evaluating both treatment response and thrombotic risk in
thrombocytosis.
Blood, Vol. 91 No. 4 (February 15), 1998:
pp. 1288-1294
© 1998 by The American Society of Hematology.
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