THROMBOTIC COMPLICATIONS IN ESSENTIAL THROMBOCYTHEMIA WITH RELATIVELYLOW PLATELET COUNTS

Essential thrombocythemia (ET) is often associated with thrombotic and hemorrhagic complications, mostly at platelet counts exceeding 600 x 10(9)/L. There are, however, a few reports of such complications in ET at considerably lower platelet levels and the therapeutic approach to affected patients with relatively low platelet counts is still contro versial. In the present study, the first to directly address the issue of hemostatic manifestations at relatively low platelet counts, we ha ve determined the lowest platelet counts associated with such manifest ations in 56 consecutive ET patients. Clinical manifestations related to ET were recorded in 46 (82%) patients. Of the symptomatic patients, 32 (70%) had symptoms at platelet counts lower than 600 x 10(9)/L, 23 (50%) at counts lower than 500 x 10(9)/L, 10(22%) at counts lower tha n 400 x 10(9)/L, and 6 patients (13%) at platelet counts as low as 300 -350 x 10(9)/L. Severe complications occurred at platelet counts lower than 600 x 10(9)/L in 10 patients (22%), lower than 500 x 10(9)/L in 7 (15%), and at lower than 400 x 10(9)/L in 2 (4%). Thrombotic neurolo gic symptoms were the most common (31 patients, 67%), followed by peri pheral vascular symptoms (17 patients, 37%); hemorrhagic complications were relatively rare (3 patients, 7%). In most cases, cessation or im provement of clinical manifestations was observed only after further r eduction in platelet counts. In conclusion, thrombotic manifestations, including severe ones, are not uncommon in ET at relatively low plate let counts. We recommend that symptomatic patients with relatively low platelet counts be treated and the platelet counts further reduced we ll into the lower normal range. (C) 1997 Wiley-Liss, Inc.