Persistent High Platelet Count Despite Hydroxycarbamide Treatment

Elevated platelet count that does not decrease despite taking hydroxycarbamide?

Hello Doctor: My girlfriend went to the emergency room in the UK due to a nosebleed that lasted five to six hours, accompanied by blood clots.
The blood test report suggested a possible diagnosis of thrombocytosis.
Currently, the doctor has advised against flying home for treatment until her platelet count decreases from 2600 to 1000.
She has started treatment with hydroxycarbamide, taking one pill daily for the first week, but her platelet count increased instead of decreasing.
In the second week, she began taking two pills daily, and her count decreased from 2600 to 2000.
However, the doctors in the UK felt this was too slow and increased her dosage to three pills daily.
In the third week, the doctor reported no change in her platelet count, but during this time, the frequency of her nosebleeds has decreased, and she has been able to stop the bleeding successfully.
Now, in the fourth week, there have been several days without any nosebleeds, but her recent blood test still showed no decrease, with a count of 2200.
Is this normal? If her platelet count hasn’t decreased, why is she able to stop the nosebleeds so quickly?

A-Bao, 30~39 year old female. Ask Date: 2020/02/27

Dr. Hong Yuanbin reply Internal Medicine

Hello, the effectiveness of hydroxycarbamide treatment indeed varies from person to person, so not everyone will experience a significant reduction in platelet counts.
As for nasal bleeding, it only requires a certain amount of active platelets to achieve hemostasis, so it may not necessarily be directly related to the treatment's effectiveness.
Regarding the disease itself, if the pharmacological treatment is inadequate, the next step to consider would be performing a bone marrow biopsy for further confirmation.
Thank you for your question.

Reply Date: 2020/02/27

More Info

The situation you described regarding your girlfriend's persistent high platelet count despite treatment with hydroxycarbamide is indeed complex and raises several important points regarding the management of thrombocytosis (high platelet count) and its associated symptoms, such as epistaxis (nosebleeds).

Firstly, it is essential to understand that hydroxycarbamide (also known as hydroxyurea) is a medication commonly used to manage conditions associated with high platelet counts, such as essential thrombocythemia. Its primary mechanism is to reduce the production of blood cells in the bone marrow, which can help lower platelet counts. However, the response to hydroxycarbamide can vary significantly from person to person. Some patients may experience a rapid decrease in platelet counts, while others may see a more gradual response or even no significant change initially.

In your girlfriend's case, starting with a platelet count of 2600 (which is significantly above the normal range of 150-450 x 10^9/L) and seeing a reduction to 2000 after increasing the dosage indicates that the medication is having some effect, albeit slower than expected. The fact that her platelet count did not drop below 2200 after four weeks of treatment could be considered within the realm of normal variability, especially since the treatment is still relatively new. It is not uncommon for patients to require several weeks or even months to achieve a stable and significant reduction in platelet counts.

Regarding the improvement in her nosebleeds, it is important to note that the ability to stop bleeding does not solely depend on the absolute platelet count. The hemostatic function of platelets is also influenced by their activity and the presence of other factors in the blood. Even with a high platelet count, if the platelets are functioning adequately, they can still effectively form clots to stop bleeding. Additionally, the reduction in the frequency of nosebleeds could be attributed to other factors, such as improved hydration, environmental changes, or even the body's natural healing processes.

It is also worth noting that while hydroxycarbamide is generally well-tolerated, some patients may experience side effects or may not respond optimally. If the platelet count remains persistently high despite treatment, further evaluation may be warranted. This could include a bone marrow biopsy to assess for any underlying myeloproliferative disorders or other hematological conditions that might be contributing to the elevated platelet levels.

In summary, while it is understandable to be concerned about the persistent high platelet count, the observed reduction in nosebleed frequency is a positive sign. It is crucial for your girlfriend to continue working closely with her healthcare provider to monitor her condition and adjust treatment as necessary. If there are ongoing concerns about her platelet counts or if she experiences any new symptoms, further investigation may be required to ensure appropriate management of her condition.

Similar Q&A

Understanding the Impact of Atezolizumab on High Platelet Count and Thrombosis

Due to thrombocytosis causing thrombosis and myocardial infarction, I am currently taking Clopidogrel and Aspirin for management. However, my platelet count remains between 850,000 and 930,000. The hematologist has indicated that I have myeloproliferative neoplasm, and since I am...

Dr. Hu Ziren reply Oncology
Hello, netizen: 1. In primary thrombocythemia, if the platelet count exceeds 1 million or there is a history of stroke (thrombosis, etc.), it is recommended to use medication to control the platelet count to below 400,000; 2. Hydroxyurea (Hydrea) works by inhibiting DNA synthesis...

Understanding Persistent Low Platelet Counts: Causes and Treatment Options

Hello, Doctor. Last August, I discovered through a blood test that I had a positive ANA and thrombocytopenia with a platelet count of about 100,000, along with a slight decrease in complement C3. All other test values were normal, and I suspected SLE, so I continued to monitor my...

Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question. Your physician's treatment approach is more aggressive; administering pulse steroids can quickly adjust the uncontrolled immune function, potentially allowing the platelet count to return to a safer level and maintain it for a longer durat...

Managing High Platelet Count: Should You Consider Oral Chemotherapy?

Hello Doctor, I underwent a stent placement due to a myocardial infarction on January 29 this year. The cardiologist discovered that my platelet count was as high as 780,000 and referred me to a hematologist. The hematologist does not recommend aggressive treatment, stating that ...

Dr. Chen Yunfang reply Oncology
Hello: Since your platelet count has risen to 930,000, you may consider taking the antiplatelet medication Angrylin. My patients who have taken this medication rarely report any adverse side effects. If it were me, I would start you on Angrylin. Thank you!

Understanding High Platelet Count: Causes, Concerns, and Next Steps

Hello Doctor, I recently received the results of my university health check, which indicated that I have thrombocytosis (586) and leukocytosis (13). I had another test done later, and although the numbers decreased, they are still high: platelets (546) and white blood cells (10.0...

Dr. Chen Yunfang reply Oncology
Hello: Please try not to worry too much; having high platelet counts is not cancer. Normally, a healthy individual's platelet count ranges from about 100,000 to 300,000. If the platelet count remains persistently elevated, such as exceeding 450,000, it could indicate two con...