Re: [MOL] Elevated Platelet count/REPLY HIGH PLATELET COUNT [03134] Medicine On Line

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Re: [MOL] Elevated Platelet count/REPLY HIGH PLATELET COUNT

Hi Celine!  There are many things that can throw off the platelet count in
making it high.  The first to remember is that the testing of platelet
counts sometimes is not accurate due to clumping.  The second thing to
remember is that there are so many things that can throw the counts off,
that it would be wise not to get too stressed at this point.  The last thing
is,  your doctor is ruling out cancer which also throws  the platelet count
off.  I have included the information you need.  I would further suggest,
that if your doctor suspects this is cancer that you try to get your
appointment moved forward with the onc. and also get at least a second
opinion.  It must be realized that today more people live with cancer than
die from it; however treatment should be started approximately with-in six
weeks.  So you are doing the right think in researching and gathering
information to make sound decisions if need be.  The last thing I would
suggest is that you understand, that if you go to a surgeon, they want to
preform an operation, if you go to an onc. they want to do chemo, and there
are many more options out there.  You will need to be a partner with your
doctor in this decision making process  It is wise to work with a team of
doctors if it is cancer.  I am wishing you all the best and hope you will
keep us informed as to your results.  Warmly, your friend, lillian

Platelet Count (005249)
CPT 85595

Synonyms Platelets; Thrombocyte Count

Specimen Whole blood and peripheral blood films

Volume 5 mL whole blood

Container Lavender-stopper (EDTA whole blood) tube; light blue-stopper
(sodium citrate) tube may be submitted when platelet clumping is a problem.

Collection Mix tube 10 times by gentle inversion.

Storage Instructions Maintain specimen at room temperature up to 24 hours.
Refrigerate up to 48 hours.

Causes for Rejection Hemolysis; clotted specimen; tube not filled with
minimum volume; improperly labeled specimen

Use Evaluate, diagnose, and/or follow up bleeding disorders, drug induced
thrombocytopenia, idiopathic thrombocytopenia purpura (acute or chronic),
disseminated intravascular coagulation, leukemia states, chemotherapeutic
management of malignant disease states; investigate purpura, petechiae;
evaluate response to platelet transfusions, steroids, or other therapy

Limitations Clumping may cause false low count.1 Platelet satellitism around
neutrophils will cause a pseudothrombocytopenia. RBC or WBC fragments
including fragmented fragile leukemic cells and neutrophil pseudoplatelet2
may cause falsely elevated counts.

Methodology Automated cell counter

Additional Information The platelet, of growing practical clinical
importance in hemostatic considerations and a variety of medical/surgical
processes is also fundamental to etiologic considerations of
arteriosclerotic3 and malignant disease.4 Careful estimate of platelet
number from stained peripheral blood smear can provide useful information. A
variety of factors affect the distribution of platelets on a peripheral
blood smear, and thus platelet estimates lack precision. Capillary blood
platelet counts (c.f. to venous blood counts) may be significantly
underestimated. Platelets are often clumped on smears obtained from
capillary blood, contributing to imprecision. A small whole blood clot or
very small fibrin clots in the EDTA anticoagulated specimen will usually be
associated with clumping of platelets on the slide, and with a false low
platelet count. Quantitative platelet disorders have varied etiology.
Thrombocytopenia may have an immunologic basis, the result of production
deficiency due to the effect of drugs or physical agents, abnormal platelet
pooling or increased destruction (eg, sequestration by large vascular
tumor), or result from a variety of probably nonimmunologic mechanisms (eg,
hypersplenism). Decreases may occur after bleeding, transfusion, infections,
or relating to defective production of or regulation by thrombopoietin.
Drugs and chemicals associated with thrombocytopenia often on an immune
mediated basis5 or as the result of marrow suppression include quinidine,
quinine, heparin, gold salts, sulfas, rifampicin, ASA, digitoxin, apronal,
chlorothiazides, chlorpropamide, meprobamate, antihistamines,
chloramphenicol, penicillin, DDT, benzol, a variety of other industrial
organic chemicals, diphenylhydantoin, PAS, hydrochlorothiazide,
phenylbutazone, and a variety of antineoplastic chemotherapeutic agents. ASA
acts by acetylating cyclo-oxygenase.

Thrombocytosis is less common, but likewise varied in etiology: physiologic
(eg, postpartum, or after exercise); myeloproliferative syndromes (eg,
thrombocythemia, some cases of chronic myelogenous leukemia, myelofibrosis
with myeloid metaplasia); rebound following thrombocytopenia, marrow
regenerative activity after bleeding episode, hemophilia, iron deficiency;
asplenism, infections, inflammatory or malignant disease, especially
carcinomatosis. Oral contraceptives may cause slight increase.

Congenital causes of thrombocytopenia include Wiskott-Aldrich syndrome,
May-Hegglin anomaly, thrombocytopenia with absent radius, and
Bernard-Soulier syndrome. See table.

Inherited Abnormalities of Platelet Production (Characterized by
Condition Inheritance Abnormality Therapy
May-Hegglin Autosomal Dominant Severe thrombocytopenia Platelet replacement
Wiskott-Aldrich Sex-linked Severe thrombocytopenia with small platelets
Possibly splenectomy
Congenital thrombopoietin deficiency ? Autorecessive Severe thrombocytopenia
Plasma transfusion
Thrombocytopenia with absent radius Autorecessive Moderate thrombocytopenia
Platelet replacement
Abnormalities of Platelet Function, Familial Transmission,
Thrombasthenia Absent clot retraction, absent aggregation, mild
thrombocytopenia Platelet replacement, steroids
Bernard-Soulier syndrome Giant platelets, absent Ristocetin® aggregation
Platelet replacement
Platelet storage pool disease Absent aggregation with collagen, mild
thrombocytopenia, absent dense granules with decreased platelet serotonin
Splenectomy, platelet replacement
Hermansky-Pudlak syndrome Aggregation abnormal with epinephrine and
collagen, decreased dense granules and absent ADP stores Platelet
Release reaction abnormalities Absent second wave aggregation with
epinephrine and collagen, absent PF-3 release, varied inheritance Platelet
>From Penner J, Blood Coagulation Laboratory Manual, University of Michigan
Medical School, Sept, 1979, with permission.

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