The Link Between High Platelet Counts and Lupus
Lupus is an autoimmune disease that causes inflammation and damage to various body tissues. High platelet counts, known medically as thrombocytosis, are more common in people with lupus. Understanding this link can help monitor and manage lupus symptoms.
What is Lupus?
Lupus is an autoimmune condition where the immune system mistakenly attacks healthy cells and organs. This can cause widespread inflammation and pain in areas like the joints, skin, kidneys, blood cells, brain, heart, and lungs.
Symptoms of lupus may include fatigue, fever, swollen joints, muscle pain, rashes, chest pain, hair loss, and sensitivity to sunlight. Symptom severity varies from mild to life-threatening.
While the exact causes are unknown, lupus is linked to genetic, environmental, and hormonal factors. Lupus is more common in women and typically develops between ages 15-44.
What is Thrombocytosis?
Thrombocytosis refers to higher than normal platelet counts in the blood. Platelets are small blood cells involved in clotting. Normal platelet counts range between 150,000-450,000 platelets per microliter.
In thrombocytosis, platelet counts exceed 450,000 platelets per microliter. When counts are extremely high, over 1 million, it is called essential thrombocythemia.
Thrombocytosis itself often has no symptoms. But it can contribute to complications like blood clots, bleeding problems, stroke, and heart attack in some cases.
Link Between Lupus and High Platelets
Studies show a strong association between systemic lupus erythematosus (SLE) and thrombocytosis. Up to 57% of lupus patients have elevated platelet levels compared to the general population.
The reasons for this link are not fully known. Researchers believe chronic inflammation from lupus influences megakaryocytes, the bone marrow cells that produce platelets. This disrupts normal platelet production.
Hormonal factors also likely contribute. Estrogen can drive increased platelet counts. This may help explain why thrombocytosis is most common in menstruating women with lupus.
Complications of High Platelets in Lupus Patients
While thrombocytosis alone often isn't problematic, the combination with lupus may increase complications like:
Blood Clots
Higher platelet levels make the blood “stickier” and more likely to form clots. Lupus also causes inflammation of blood vessels. Together, these factors increase clotting risk.
Blood clots can obstruct blood flow causing stroke, pulmonary embolism, deep vein thrombosis, and other concerns. Patients with both lupus and thrombocytosis have a 1 in 4 chance of blood clots.
Bleeding Problems
Ironically, thrombocytosis can also create issues with abnormal bleeding in some lupus patients. When platelets are very high they may not function properly leading to bruising, nosebleeds, bleeding gums, etc.
Pregnancy Complications
Lupus and thrombocytosis separately increase the chance of miscarriage, preeclampsia, and other pregnancy complications. Together they further worsen these risks.
Atherosclerosis
The inflammation of lupus damages blood vessels over time leading to plaque buildup and atherosclerosis. High platelets accelerate this process by promoting fatty deposits in arteries.
Patients with both lupus and thrombocytosis have a 1 in 5 chance of developing atherosclerosis.
Diagnosing High Platelets in Lupus
Doctors may uncover thrombocytosis in lupus patients through:
Complete Blood Count Testing
A complete blood count (CBC) test checks levels of different cells in the blood. It can detect increased platelet counts along with low red blood cells or white blood cells, which also occur in lupus.
Physical Exams
Enlarged spleen is found in around 1/3 of lupus patients with thrombocytosis. Doctors may detect an enlarged spleen during routine physical exams.
Patient History
Looking at a patient’s medical history can reveal if thrombocytosis developed after being diagnosed with lupus, which suggests an association.
Doctors may also ask about family history, since some rare hereditary conditions can cause high platelets.
Bone Marrow Biopsy
This test takes a small sample of bone marrow to examine blood cell production. It can provide clues about what’s causing thrombocytosis, like bone marrow inflammation.
Treatment and Management of High Platelets in Lupus
Treatments for elevated platelets in lupus patients aim to prevent complications like stroke, pulmonary embolism, atherosclerosis and pregnancy loss.
Medications
Commonly prescribed medications may include:
- Blood thinners like warfarin or heparin to reduce clotting
- Anti-inflammatories to lower high platelet counts
- Immunosuppressants like corticosteroids to manage lupus activity
- Hydroxychloroquine to help control lupus symptoms
Plasma Exchange
This procedure filters the blood to remove antibodies and problematic immune cells. It can quickly lower high platelet counts during severe flares.
Splenectomy
Surgically removing an enlarged spleen may help normalize platelet production in some cases. But this option has risks including infections.
Avoid Estrogen
Since estrogen can increase platelet counts, patients may be advised to avoid birth control pills, hormone replacement therapy, or estrogen-producing medications.
Platelet Donation
For extremely high platelets, patients may need periodic plateletpheresis to filter and donate excess platelets from their blood.
Outlook for Lupus Patients with High Platelets
With treatment, most lupus patients with thrombocytosis can manage symptoms and avoid serious complications. Close monitoring of platelet levels and lupus activity is key.
Patients should follow their treatment plan, attend regular doctor visits, and contact their physician if they notice potential signs of blood clots or bleeding problems. Staying current with vaccines is also recommended.
In most cases, vigilant management means patients with lupus and high platelets can maintain a positive long-term outlook.
FAQs
Why do lupus patients get high platelets?
The chronic inflammation of lupus likely disrupts normal platelet production in the bone marrow. Hormonal influences may also contribute to increased platelet counts.
How are high platelets diagnosed in lupus?
Doctors may detect thrombocytosis through complete blood count tests, physical exams showing an enlarged spleen, looking at the patient's medical history, or bone marrow biopsies.
What are the risks of high platelets with lupus?
Complications can include increased blood clots, bleeding problems, atherosclerosis, miscarriage, and other pregnancy complications.
How are high platelets treated in lupus patients?
Treatment may involve medications like blood thinners and anti-inflammatories, plasma exchange, splenectomy, avoiding estrogen, and platelet donation.
Is the outlook good for lupus patients with high platelets?
With close monitoring and proper treatment, most patients can manage their thrombocytosis and avoid serious complications from it.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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