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Causes of increased and decreased platelets
Last reviewed: 06.07.2025
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An increase in the number of platelets in the blood (thrombocytosis) can be primary (the result of primary proliferation of megakaryocytes) and secondary, reactive, arising against the background of some disease.
The following diseases can cause an increase in the number of platelets in the blood.
- Primary thrombocytosis: essential thrombocythemia (the number of platelets can increase to 2000-4000×10 9 /l or more), erythremia, chronic myelogenous leukemia and myelofibrosis.
- Secondary thrombocytosis: acute rheumatic fever, rheumatoid arthritis, tuberculosis, liver cirrhosis, ulcerative colitis, osteomyelitis, amyloidosis, acute bleeding, carcinoma, lymphogranulomatosis, lymphoma, condition after splenectomy (within 2 months or more), acute hemolysis, after surgery (within 2 weeks).
A decrease in the number of platelets in the blood to less than 180×10 9 /l (thrombocytopenia) is observed with the suppression of megakaryocytopoiesis, a violation of platelet production. Thrombocytopenia can be caused by the following conditions and diseases.
Thrombocytopenia caused by decreased platelet production (hematopoietic insufficiency).
- Acquired:
- idiopathic hematopoietic hypoplasia;
- viral infections (viral hepatitis, adenoviruses);
- intoxications (myelosuppressant chemicals and drugs, some antibiotics, uremia, liver disease) and ionizing radiation;
- tumor diseases (acute leukemia, metastases of cancer and sarcoma in the red bone marrow; myelofibrosis and osteomyelosclerosis);
- megaloblastic anemia (deficiency of vitamin B 12 and folic acid);
- nocturnal paroxysmal hemoglobinuria.
- Hereditary:
- Fanconi syndrome;
- Wiskott-Aldrich syndrome;
- May-Hegglin anomaly;
- Bernard-Soulier syndrome.
Thrombocytopenia caused by increased platelet destruction.
- Autoimmune - idiopathic (Werlhof's disease) and secondary [in systemic lupus erythematosus (SLE), chronic hepatitis, chronic lymphocytic leukemia, etc.] in newborns due to the penetration of maternal autoantibodies.
- Isoimmune (neonatal, post-transfusion).
- Haptenic (hypersensitivity to certain drugs).
- Associated with viral infection.
- Associated with mechanical damage to platelets: during heart valve replacement, extracorporeal circulation; during nocturnal paroxysmal hemoglobinuria (Marchiafava-Micheli disease).
Thrombocytopenia caused by platelet sequestration: sequestration in hemangioma, sequestration and destruction in the spleen (hypersplenism in Gaucher disease, Felty's syndrome, sarcoidosis, lymphoma, tuberculosis of the spleen, myeloproliferative diseases with splenomegaly, etc.).
Thrombocytopenia caused by increased platelet consumption: disseminated intravascular coagulation (DIC) syndrome, thrombotic thrombocytopenic purpura, etc.
- The number of platelets in the blood at which correction is necessary:
- below 10-15×10 9 /l - in the absence of other risk factors for bleeding;
- below 20×10 9 /l - in the presence of other risk factors for bleeding;
- below 50×109/l - during surgical interventions or bleeding.
Diseases and conditions associated with changes in MPV
Increase MPV |
Lower MPV |
Idiopathic thrombocytopenic purpura Bernard-Soulier syndrome May-Hegglin anomaly Posthemorrhagic anemia |
Wiskott-Aldrich syndrome |