Q. I had a CBC done where my platelet count was 498. Is this platelet number really high?

Answered by
Dr. Mubashir Razzaq Khan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 04, 2021

Hello doctor.

I just had a CBC done where my platelet count was 498. My last one was 423 about a year ago. I have not been feeling well lately with a sore throat and swollen lymph nodes. I also had the second COVID vaccine two weeks ago, and I was told that it could be the cause of the swollen lymph nodes. Everything else in my CBC was normal. Is this platelet number really high?



Welcome to

Elevated platelets:

Grade 1 thrombocytosis: platelets 550-649.

Grade 2 thrombocytosis: platelets 650-749.

Grade 3 thrombocytosis: platelets 750-849.

Grade 4 thrombocytosis: platelets 850-1099.

Grade 5 thrombocytosis: platelets 1100 or more.

Elevated platelets are seen in iron deficiency anemia, infections, inflammation, drug-induced, and very rarely, it could be a part of essential thrombocythemia (commonly seen in young to elderly age groups but not in children). To rule out the causes of secondary thrombocytosis. If all causes are excluded, get JAK2, Exon12, and CALR mutations tested. Even in primary thrombocytosis, also called essential thrombocythemia, these mutations are negative frequently. In cases of secondary thrombocytosis, the treatment of elevated platelets is to treat the cause. In primary thrombocythemia, if JAK2 is negative, the treatment is cytoreductive therapy by hydroxyurea. The goal is to keep platelets below thousands. Thrombolytic drugs such as Aspirin, Clopidogrel, and Warfarin are also a part of therapy. For JAK2 positive patients.

Ruxolitinib tablets are given in a dose of 5 to 15 mg per day. Other option is IFN (interferons) alpha in low dose (45 ug/week) in both JAK2 positive or negative cases. CALR positive cases show superior results in this mode. It could take years to cure the disease. This is not a life-threatening disease unless thromboembolism involves the heart, lungs, and brain. Sometimes, the first manifestation of the disease is thromboembolic events.

Your case seems re-active.

Please get CRP (c-reactive protein), ESR (erythrocyte sedimentation rate), Ferritin, IgE, levels, and stool CE tests done and send us the results. Do you have any lungs related issues such as COPD or some allergic tendencies?

Please reply in detail.

Hello doctor,

I actually do have some allergic tendencies. Lately, I have been developing a swollen rash. Anytime deep pressure is put on my back and upper arms (discovered this during a deep tissue massage). I also have a sore throat that is sometimes itchy, and when I take a Benadryl, it will go away. I do not have any history of lung issues, only a mild case of asthma.



Welcome back to

Asthma is a lung issue. Take antihistamines, a bronchodilator, steroids separately or in combination as advised by your physician. Skin rash seems allergic, and it can be controlled by antihistamines and avoiding precipitation factors. Platelets seem as a part of allergies and asthmatic tendencies. Monitor the count twice a year.


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