Thrombocytosis

Thrombocytosis means that you have too many platelets in your blood. Platelets are a type of blood cell that aid in the clotting process to stop bleeding. Having an excess of platelets can make the blood too sticky.

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Impact of thrombocytosis on fertility

Excess platelets can lead to thrombosis (blood clots) and abnormal bleeding. These can cause fertility problems and increase the risk of complications during pregnancy, including miscarriage, stillbirth, premature delivery, and newborn death. These problems can happen due to an interruption in the blood flow between the placenta and the baby. Thrombocytosis is a potential cause of recurrent miscarriage – having 3 or more miscarriages in a row.

Potential causes of thrombocytosis

There are 2 types of thrombocytosis, and each type has different causes. 

Essential thrombocythemia (also known as primary thrombocytosis) is a rare blood disorder that causes the bone marrow to produce excess platelets. This happens due to a genetic mutation that changes platelet production. 

Reactive thrombocytosis (also known as secondary thrombocytosis) is the second form of this condition. It is caused by the following things, among others:

• Iron deficiency
• Blood loss
• Cancer
• Infections 
• Hemolytic anemia
• Inflammatory health conditions (such as rheumatoid arthritis or inflammatory bowel disease)
• Injury
• Kidney failure
• Certain medications
• Surgery (particularly on the abdomen or removal of the spleen)
• Treatment of a vitamin B12 deficiency

Symptoms of thrombocytosis

Many people with thrombocytosis don’t experience symptoms. But watch out for these symptoms of a blood clot: 

• Headache and migraine
• Weakness or dizziness
• Speech changes
• Shortness of breath
• Nausea
• Chest pain

In serious cases, having excess platelets can cause blood clots in the abdomen and increase the chance of having a heart attack or stroke. Smoking, diabetes, and high blood pressure can increase the risk of blood clots. 

Symptoms of abnormal bleeding associated with thrombocytosis include:

• Easy bruising
• Blood in stool
• Nose, mouth, or gum bleeding

Diagnosis of thrombocytosis

Doctors diagnose thrombocytosis based on the results of a complete blood count (CBC), which includes a count of your platelets. You will likely have additional tests to find the underlying cause of your high platelet count. 

In case your doctor can’t find what is causing thrombocytosis, they will perform diagnostic tests to check for essential thrombocythemia, including: 

• A peripheral blood smear to look for abnormalities in platelets. 
• Genetic tests to detect mutations. 
• A biopsy of your bone marrow to check for unusual cells.

Treatment to improve fertility

You should bring your platelet count to a healthy level before conceiving to raise your chances of a healthy pregnancy. Your treatment plan will depend on if you have essential thrombocythemia or reactive thrombocytosis.  

The treatment for women with essential thrombocythemia usually includes aspirin and/or interferon-alpha to normalize the platelet count. Speak with your doctor about the best course of action for you. For women with reactive thrombocytosis, the treatment should be directed at what is causing the high platelet count. Iron supplementation may restore balance to platelet levels in women with inflammatory bowel disease and iron deficiency. Aspirin may be prescribed to women with very high platelet counts to reduce the risk of stroke and thrombosis. 

During pregnancy, treatment with anticoagulant medication (blood thinners) such as aspirin may help prevent blood clots and improve the chances of a successful pregnancy.

Getting regular checkups during pregnancy can also help reduce the risk of complications. Women with thrombocytosis are recommended to have close monitoring by a hematologist (specialist in blood disorders) and gynecologist. 

If necessary, intrauterine insemination with minimal hormonal stimulation is recommended for women with this condition. 

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