Rapid Reduction of Platelet Numbers in Thrombocytosis

Abstract

Thrombocytosis has been reported during chemotherapy with gemcitabine (GEM). A 71-year-old male patient who developed asymptomatic thrombocytosis (1,749 x 10(3)/microl), secondary to GEM chemotherapy for lung carcinoma, was submitted to therapeutic plateletpheresis (TP). We adapted the software of the productive dual-needle plateletpheresis of our cell separator in order to reduce the procedure time and the plasma volume harvested. With 2 low-volume TP in 24 h, we achieved a 55% global reduction of the platelet count. While there are no accepted indications for prophylactic plateletpheresis in asymptomatic patients and the measured count should not, by itself, determine whether platelet reduction is indicated, a drastic reduction of an extremely high platelet count, especially if obtained with a relatively short procedure, can be important to prevent acute severe sequelae.

Chemotherapy-Related Thrombocytosis: Does It Increase the Risk of Thromboembolism?

“…Although thrombocytopenia is a well-known dose-limiting toxicity, gemcitabine-related thrombocytosis has been reported infrequently in clinical trials [8,9,10]. In a phase I/II study, 59% of patients with advanced non-small cell lung cancer who were treated with a combination of gemcitabine and vinorelbine developed transient thrombocytosis [12].…”

“…Based on previous reports, an 8% baseline risk of thromboembolism was expected in patients treated with gemcitabine-based therapy [8,9,10]. We estimated a 4% absolute increase in the risk of thromboembolism in patients with thrombocytosis.…”

Thrombocytosis in the NICU

“…Platelet removal via platelet pheresis is highly effective but reserved for myeloproliferative etiologies wherein extensive thrombosis or hemorrhage has occurred [43,44]. Because of the low incidence of thrombosis and rare occurrence of hemorrhage in ST, platelet pheresis is not indicated in ST.…”