Q. Can reactive thrombocytosis cause stroke?

Answered by
Dr. Sadaf Mustafa
and medically reviewed by iCliniq medical review team.
Published on May 19, 2016 and last reviewed on: Oct 09, 2018

Hello doctor,

donated plasma through plasmapheresis. When the IV was initially inserted, my blood did not flow through the machine. The technician came by and wiggled the IV, but the blood still did not flow. The technician then switched the IV to my other arm. It began to flow after about five minutes. I completed the process successfully. I was instructed to wait for five minutes before leaving to make sure I felt fine. The following info is an excerpt from my discharge papers. Immediately upon entering her vehicle a 35 year old female presented with nausea, vomiting, weakness, and fatigue. Patient noted that she donated plasma the day before and suffered severe side effects immediately upon entrance to her vehicle. Side effects she noted were severe and prolonged nausea, vomiting and dry heaves. As well as stomach pain, tingling in arm, slurred speech, tunnel vision and cold sweats. She was told by the plasma donation center that possible side effects of plasma donation can include most of issues noted above, and to rest and drink plenty of fluids to counteract. Patient went home, drank fluids and slept the remaining of the day as instructed. The following morning, her symptoms persisted so she called emergency number. Upon workup, patient presented with thrombocytosis, elevated WBC, severely depleted iron levels and MRI and CT scan confirmed acute ischemic stroke. Can a person with reactive thrombocytosis suffer an ischemic stroke from donating plasma or undergoing plasmapheresis? I am taking medicines for BP, cholesterol and also taking Aspirin and Iron. Please see the attachment.

Dr. Sadaf Mustafa

General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

  • It is very rare for reactive thrombocytosis to cause a stroke. It may happen if you have other risk factors for stroke like hypertension and high cholesterol.
  • However, I am hoping that they have ruled out other causes of thrombocytosis (increased platelet count). I understand that you were also having anemia (attachment removed to protect patient identity).
  • I am not sure what were your hemoglobin levels and platelets count numbers before the donation.
  • Having thrombocytosis puts you at risk of having a stroke. But, in those situations the platelets are dysfunctional and having too many of them cause clumping and thrombosis.
  • Please share your blood work. I would be interested in looking into numbers before and after the donation, also a peripheral smear if available.
  • Again, I am not sure how high your platelets were. I would still suggest that you see a hematologist as an outpatient to rule out essential thrombocytosis.
  • The most important point to consider here is that iron deficiency anemia can also cause secondary thrombocytosis.
  • I am afraid it might be a combination of all the factors including anemia, trauma to the vessel and the predisposing factors for stroke (hypertension and high cholesterol).
  • I would feel more comfortable if JAK2 mutation analysis is done to rule out essential thrombocytosis.

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