Critical Care: Miscellaneous Critical Care |

Thrombocytosis: A Delayed Marker of Stress FREE TO VIEW

Deepthi Gandhiraj, MD; Firas Jafri, MD; Dipak Chandy, MD
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Westchester Medical Center, Valhalla, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):332A. doi:10.1016/j.chest.2016.08.345
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SESSION TITLE: Miscellaneous Critical Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Reactive thrombocytosis is occasionally seen in hospitalized patients. The rise is often gradual, usually beginning several days after the period of maximal stress. Although usually benign and self-limited, some cases have been associated with increased mortality especially in patients with cardiovascular risk factors due to the increased platelet aggregation. Reactive thrombocytosis has been reported to occur as a response to a variety of conditions such as major trauma, surgery, neoplasms and inflammation. Studies have not clearly elucidated the types of patients at risk, the stressors that are more likely to lead to reactive thrombocytosis as well as the temporal relationship between the stressor and the thrombocytosis. The aim of our study was to explore these relationships.

METHODS: Medical records of all patients who had a platelet count > 600k/mm3 during their hospitalization at Westchester Medical Center from 8/1/15 to 1/31/16 were reviewed. Patients who had any oncological diagnosis or a platelet count > 600k/mm3 at the time of admission were excluded. To ensure exposure to a major stressor and to more accurately assess the onset of the stress, only patients admitted to an intensive care unit (ICU) were included. The onset of the major stressor (major trauma, burns, emergency surgery, septic shock, respiratory failure, etc.) was determined by a reviewer while being blinded to the date of the maximal platelet count.

RESULTS: The charts of 50 patients who met our criteria were reviewed. The number of days between the onset of stress and the date of maximal platelet count ranged from 3-25 days (mean: 15 +/- 5 days). The maximal platelet count after a stressor ranged from 638k-1277k/mm3 (mean: 813k +/- 154k/mm3). On average, the platelet count increased by almost 7 times when compared to the lowest platelet count during that hospital stay. Of the 50 patients analyzed, 39 were admitted in ICU for surgical stressors while only 11 were admitted for medical stressors. The mean maximal platelet count among patients with surgical stressors was 825k +/- 160 k/mm3 and among patients with medical stressors was 768k +/- 125 k/mm3. Among the 50 patients reviewed, 37 were men and 13 were women.

CONCLUSIONS: Thrombocytosis is a delayed marker of stress occurring among patients admitted with medical or surgical stress requiring ICU level of care. On average, the maximal platelet count was observed more than 2 weeks after the onset of stress. Thrombocytosis appeared to be more common among patients with surgical than with medical stressors. We also found thrombocytosis to be more common in men.

CLINICAL IMPLICATIONS: Understanding the impact that stress has on platelet physiology may help explain the broad swings that are often seen in platelet counts during a hospitalization. Reactive thrombocytosis may also play a role in thrombotic events such as deep vein thrombosis, myocardial infarction and strokes that are seen in the outpatient setting after hospitalization, especially following surgery.

DISCLOSURE: The following authors have nothing to disclose: Deepthi Gandhiraj, Firas Jafri, Dipak Chandy

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