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increase in the number of platelets in the blood which tends to cause clots to form; associated with many neoplasms and chronic infections and other diseases

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/06/29 21:24:40」(JST)

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Thrombocytosis (or thrombocythemia) is the presence of high platelet counts in the blood, and can be either primary (also termed essential and caused by a myeloproliferative disease) or reactive (also termed secondary). Although often symptomless (particularly when it is a secondary reaction), it can predispose to thrombosis in some patients.

In a healthy individual, a normal platelet count ranges from 150,000 and 450,000 per mm³ (or microlitre) (150–450 x 10⁹/L).^[1] These limits, however, are determined by the 2.5th lower and upper percentile, and a deviation does not necessary imply any form of disease. Nevertheless, counts over 750,000 (and especially over a million) are considered serious enough to warrant investigation and intervention.

Signs and symptoms

High platelet levels do not necessarily signal any clinical problems, and are picked up on a routine full blood count. However, it is important that a full medical history be elicited to ensure that the increased platelet count is not due to a secondary process. Often, it occurs in tandem with an inflammatory disease, as the principal stimulants of platelet production (e.g. thrombopoietin) are elevated in these clinical states as part of the acute phase reaction.

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

A very small segment of patients report symptoms of erythromelalgia, a burning sensation and redness of the extremities that resolves with cooling and/or aspirin use.^{[citation needed]}

Scientific literature sometimes excludes thrombocytosis from the scope of thrombophilia by definition,^[2] but practically, by the definition of thrombophilia as an increased predisposition to thrombosis,^[3]^[4] thrombocytosis (especially primary thrombocytosis) is a potential cause of thrombophilia. Conversely, secondary thrombocytosis very rarely causes thrombotic complications.^[5]

Diagnosis

Laboratory tests might include: full blood count, liver enzymes, renal function and erythrocyte sedimentation rate.

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

Causes

Increase platelet counts can be due to a number of disease processes:

Essential (primary)
- Essential thrombocytosis (a form of myeloproliferative disease)
- Other myeloproliferative disorders such as chronic myelogenous leukemia, polycythemia vera, myelofibrosis
Reactive (secondary)
- Inflammation
- Surgery (which leads to an inflammatory state)
- Hyposplenism (decreased breakdown due to decreased function of the spleen)
- Splenectomy
- Asplenia (absence of normal spleen function)
- Iron deficiency anemia or hemorrhage

Over-medication with drugs that treat thrombocytopenia, such as eltrombopag or romiplostim, may also result in thrombocytosis. Other causes include the following

Kawasaki disease
Soft tissue sarcoma
Osteosarcoma
Dermatitis (rarely)
Inflammatory bowel disease
Rheumatoid arthritis
Nephritis
Nephrotic syndrome
Bacterial diseases, including pneumonia, sepsis, meningitis, urinary tract infections, and septic arthritis.^[6]

The vast majority of causes of thrombocytosis are acquired disorders, but in a few cases, they may be congenital, such as thrombocytosis due to congenital asplenia.^[7]

Treatment

Often, no treatment is required or necessary for reactive thrombocytosis. In cases of reactive thrombocytosis of more than 1,000x10⁹/L, it may be considered to administer daily low dose aspirin (such as 65 mg) to minimize the risk of stroke or thrombosis.^[8]

However, in primary thrombocytosis, if platelet counts are over 750,000 or 1,000,000, and especially if there are other risk factors for thrombosis, treatment may be needed. Selective use of aspirin at low doses is thought to be protective. Extremely high platelet counts in primary thrombocytosis can be treated with hydroxyurea (a cytoreducing agent) or anagrelide (Agrylin).^[9]

References

Schafer AI (March 2004). "Thrombocytosis". N. Engl. J. Med. 350 (12): 1211–9. doi:10.1056/NEJMra035363. PMID 15028825.

^ Kumar & Clark (2005). "8". Clinical Medicine (Sixth ed.). Elsevier Saunders. p. 469. ISBN 0-7020-2763-4. |accessdate= requires |url= (help)
^ "Management of patients with thrombophilia". Drug and Therapeutics Bulletin 33 (1): 6–8. 1995. doi:10.1136/dtb.1995.3316. PMID 7587981. edit [1]
^ Mitchell RS, Kumar V, Abbas AK, Fausto N (2007). "Chapter 4". Robbins Basic Pathology (Eighth ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7.
^ Heit JA (2007). "Thrombophilia: common questions on laboratory assessment and management". Hematology Am. Soc. Hematol. Educ. Program 2007 (1): 127–35. doi:10.1182/asheducation-2007.1.127. PMID 18024620.
^ medscape > Pediatric Thrombocytopenia By Susumu Inoue. Updated: Apr 19, 2010
^ http://emedicine.medscape.com/article/959378-overview
^ Chanet, V.; Tournilhac, O.; Dieu-Bellamy, V.; Boiret, N.; Spitz, P.; Baud, O.; Darcha, C.; Travade, P.; Laurichesse, H. (2000). "Isolated spleen agenesis: A rare cause of thrombocytosis mimicking essential thrombocythemia". Haematologica 85 (11): 1211–1213. PMID 11064471. edit [2]
^ Thrombocytosis, Secondary Treatment & Management from Medscape. Author: Koyamangalath Krishnan, MD, FRCP, FACP; Chief Editor: Emmanuel C Besa, MD. Updated: Oct 4, 2009
^ Harrison, CN; Campbell PJ, Buck G, Wheatley K, East CL, Bareford D, Wilkins BS, van der Walt JD, Reilly JT, Grigg AP, Revell P, Woodcock BE, Green AR, United Kingdom Medical Research Council Primary Thrombocythemia 1 Study. (2005). "Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia.". NEJM 353 (1): 33–45. doi:10.1056/NEJMoa043800. PMID 16000354. Cite uses deprecated parameters (help)

UpToDate Contents

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1. 血小板増加症患者に対するアプローチ approach to the patient with thrombocytosis
2. 本態性血小板血症の診断および臨床症状 diagnosis and clinical manifestations of essential thrombocythemia
3. 本態性血小板血症の予後および治療 prognosis and treatment of essential thrombocythemia
4. 急性骨髄性白血病の分類 classification of acute myeloid leukemia
5. 好中球増多症の患者へのアプローチ approach to the patient with neutrophilia

English Journal

Outcomes after acute ischemic stroke in patients with thrombocytopenia or thrombocytosis.

Furlan JC1, Fang J2, Silver FL3.
Journal of the neurological sciences.J Neurol Sci.2016 Mar 15;362:198-203. doi: 10.1016/j.jns.2016.01.044. Epub 2016 Jan 23.
INTRODUCTION: Thrombocytopenia may be associated with a greater risk of cerebral hemorrhage and thrombocytosis may be associated with a greater risk of cerebral thrombosis. There is a paucity of studies focused on the potential association between blood platelet count (BPC) and outcomes after acute
PMID 26944147

MPL W515L expression induces TGFβ secretion and leads to an increase in chemokinesis via phosphorylation of THOC5.

Whetton AD1, Azmi NC1, Pearson S1, Jaworska E1, Zhang L1, Blance R1, Kendall AC2, Nicolaou A2, Taylor S1, Williamson AJ1, Pierce A1.
Oncotarget.Oncotarget.2016 Feb 23. doi: 10.18632/oncotarget.7639. [Epub ahead of print]
The thrombopoietin receptor (MPL) has been shown to be mutated (MPL W515L) in myelofibrosis and thrombocytosis yet new approaches to treat this disorder are still required. We have previously shown that transcriptome and proteomic effects do not correlate well in oncogene-mediated leukemogenesis. We
PMID 26919114

How We Identify and Manage Patients with Inadequately Controlled Polycythemia Vera.

Reiter A1, Harrison C2.
Current hematologic malignancy reports.Curr Hematol Malig Rep.2016 Feb 19. [Epub ahead of print]
Polycythemia vera (PV) is a chronic myeloproliferative neoplasm (MPN) characterized by an overactive Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway through mutations in JAK2 exons 12 or 14 (JAK2 V617F). The dominant clinical characteristics include erythrocytosis (w
PMID 26894383

Japanese Journal

Persistent thrombocytosis in elderly patients with rare hyposplenias that mimic essential thrombocythemia

IMASHUKU Shinsaku,KUDO Naoko,KUBO Kagekatsu,TAKAHASHI Naotu,TOHYAMA Kaoru
International journal of hematology 95(6), 702-705, 2012-06-01
NAID 10030793782

ペメトレキセドを含まない化学療法により完全奏効が得られた上皮型悪性胸膜中皮腫の1例

田村邦宣,大搗泰一郎,柴田英輔,金村晋吾,安光亮洋,塚本吉胤,小牟田清,田端千春,福岡和也,中野孝司
気管支学 : 日本気管支研究会雑誌 34(3), 228-233, 2012-05-25
背景.悪性胸膜中皮腫は治療に抵抗する予後不良の腫瘍である.非切除例の生存期間は10〜12か月であり,化学療法で完全奏効(CR)が得られることは稀である.症例. 74歳女性,主訴は右胸部痛,アスベスト曝露歴がある.胸部圧迫感を自覚し近医を受診,右胸水貯留の指摘を受け来院した.胸水細胞診では癌胎児性抗原(CEA)染色陰性,カルレチニン染色陽性の悪性細胞が認められ,悪性胸膜中皮腫が強く疑われた.局所麻酔 …
NAID 110009457535

本態性血小板血症におけるJAK2-V617F変異の臨床的意義 : 初診時の白血球増加とJAK2-V617F変異が有意な血栓症発症リスクである

岩淵多光子,伊藤良和,大屋敷純子 [他],大屋敷一馬
東京醫科大學雜誌 70(2), 205-214, 2012-04-30
NAID 10030612531

Related Pictures

★リンクテーブル★

リンク元	「血小板増加」「血小板増加症」
拡張検索	「essential thrombocytosis」

「血小板増加」

Thrombocytosis
	Classification and external resources
ICD-10	D75.8
ICD-9	289.9
DiseasesDB	27591
MedlinePlus	000543

　　[★]

英: thrombocytosis
同: 血小板増多
関: 血小板

[show details]

血小板増加 : 約 47,300 件
血小板増多 : 約 13,400 件
血小板増加症 : 約 32,800 件
血小板増多症 : 約 5,890 件

thrombocytosis 血小板増加 : 約 84 件
thrombocytosis 血小板増加症 : 約 77 件
thrombocytosis 血小板増多 : 約 96 件
thrombocytosis 血小板増多症 : 約 69 件

一次性増加

慢性骨髄増殖症候群：慢性骨髄性白血病、真性多血症、本態性血小板血症、骨髄線維症
一次性増加では100万/μLを超えることが多く、血小板機能異常にもとづく血栓傾向や出血傾向を生じることがある。

二次性増加

反応性増加ともいう

感染および炎症性疾患：関節リウマチ、急性リウマチ熱、結節性動脈周囲炎、潰瘍性大腸炎、結核、サルコイドーシス、ウェゲナー肉芽腫症など
急性出血
溶血性貧血
鉄欠乏性貧血
悪性腫瘍：種々の癌、ホジキン病、非ホジキンリンパ腫など
脾摘後
外傷や手術後
ネフローゼ症候群
クッシング病
血小板減少状態からの回復期：抗癌薬やそのほかの原因による、骨髄抑制からの回復期
薬剤(ビンクリスチン、エピネフリン)

「血小板増加症」

　　[★]

英: thrombocytosis
同: 血小板増多症
関: 血小板、血小板減少症、血小板増加

定義

基準値(15万-25万/μl)を外れて増加した病態
臨床的には、60万/ul以上

症状

(80万/ul以上)TIA、手足のしびれ、狭心症

病因

症候性反応性の増加症 thrombocytosis

造血亢進：鉄欠乏性貧血など
癌

増殖性に産生が亢進する血小板血症 thrombocythemia

-血小板増多症

「essential thrombocytosis」

　　[★]

本態性血小板増加症

[Kumar.26Clark-1] Kumar & Clark (2005). "8". Clinical Medicine (Sixth ed.). Elsevier Saunders. p. 469. ISBN 0-7020-2763-4. |accessdate= requires |url= (help)

[dtb1995-2] "Management of patients with thrombophilia". Drug and Therapeutics Bulletin 33 (1): 6–8. 1995. doi:10.1136/dtb.1995.3316. PMID 7587981. edit [1]

[Kumar4-3] Mitchell RS, Kumar V, Abbas AK, Fausto N (2007). "Chapter 4". Robbins Basic Pathology (Eighth ed.). Philadelphia: Saunders. ISBN 1-4160-2973-7.

[Heit-4] Heit JA (2007). "Thrombophilia: common questions on laboratory assessment and management". Hematology Am. Soc. Hematol. Educ. Program 2007 (1): 127–35. doi:10.1182/asheducation-2007.1.127. PMID 18024620.

[5] scape > Pediatric Thrombocytopenia By Susumu Inoue. Updated: Apr 19, 2010

[6] ttp://emedicine.medscape.com/article/959378-overview

[7] Chanet, V.; Tournilhac, O.; Dieu-Bellamy, V.; Boiret, N.; Spitz, P.; Baud, O.; Darcha, C.; Travade, P.; Laurichesse, H. (2000). "Isolated spleen agenesis: A rare cause of thrombocytosis mimicking essential thrombocythemia". Haematologica 85 (11): 1211–1213. PMID 11064471. edit [2]

[8] Thrombocytosis, Secondary Treatment & Management from Medscape. Author: Koyamangalath Krishnan, MD, FRCP, FACP; Chief Editor: Emmanuel C Besa, MD. Updated: Oct 4, 2009

[Harrison-9] Harrison, CN; Campbell PJ, Buck G, Wheatley K, East CL, Bareford D, Wilkins BS, van der Walt JD, Reilly JT, Grigg AP, Revell P, Woodcock BE, Green AR, United Kingdom Medical Research Council Primary Thrombocythemia 1 Study. (2005). "Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia.". NEJM 353 (1): 33–45. doi:10.1056/NEJMoa043800. PMID 16000354. Cite uses deprecated parameters (help)

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thrombocytosis