In essential thrombocytosis, contrary to what might be surmised, bleeding is more of threat than thrombosis.
This is because high platelet count especially above 1 million/mm3 cause acquired von willebrand disease, much like type 2b von willebrand disease, where excessive affinity of vWF for platelet Gpib result in excessive removal of platelet-vWF complex by spleen results in thrombocytopenia and loss of high molecular weight vWF multimers.
However, incidence of erythromelalgia , transient ischemic attack and other microvascular events are also high in patients with essential thrombocytosis.
Pretty complex and contradictory, right?
- Kirtan Patolia ( BJ medical college).
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