Platelet Count

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Measures the number of platelets (thrombocytes) in the blood

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Platelet Count - Comprehensive Medical Test Information Guide

Why is it done?
- Test Measurement: Measures the number of platelets (thrombocytes) in the blood, which are small cell fragments essential for blood clotting and hemostasis.
- Primary Indications: Evaluation of bleeding disorders, assessment of thrombocytopenia (low platelets) or thrombocytosis (high platelets), monitoring anticoagulation therapy, pre-operative screening, evaluation of unexplained bruising or petechiae, and assessment of bone marrow disorders.
- Clinical Circumstances: Routine complete blood count (CBC), during investigation of abnormal bleeding or clotting, monitoring of patients on chemotherapy or immunosuppressive therapy, evaluation of suspected leukemia or lymphoma, assessment of immune thrombocytopenia (ITP), and monitoring patients with chronic liver disease or disseminated intravascular coagulation (DIC).
Normal Range
- Reference Range: 150,000 to 400,000 platelets per microliter (µL) of blood, or 150 to 400 × 10⁹/L (SI units)
- Units of Measurement: Platelets/µL (conventional) or × 10⁹/L (SI units)
- Normal Results: Platelet count within the reference range indicates adequate platelet production and function, suggesting normal hemostatic capacity.
- Low Results (Thrombocytopenia): Less than 150,000 platelets/µL; classified as mild (100,000-150,000), moderate (50,000-100,000), or severe (<50,000); indicates increased bleeding risk.
- High Results (Thrombocytosis): Greater than 400,000 platelets/µL; may indicate primary bone marrow disorders or secondary reactive increases; may increase thrombotic risk.
Interpretation
- Low Platelet Count (Thrombocytopenia) - Possible Causes: Decreased platelet production (bone marrow failure, aplastic anemia, megaloblastic anemia, leukemia, lymphoma, myelodysplastic syndrome); increased platelet destruction (immune thrombocytopenia, drug-induced, sepsis, disseminated intravascular coagulation); sequestration (liver disease, splenomegaly); dilution (massive transfusion); medications (heparin, NSAIDs, ACE inhibitors, thiazide diuretics).
- High Platelet Count (Thrombocytosis) - Possible Causes: Primary myeloproliferative disorders (essential thrombocythemia, polycythemia vera, chronic myeloid leukemia); secondary reactive increases (iron deficiency anemia, acute infection, inflammation, rheumatoid arthritis, cancer, tissue damage, surgical stress, hemorrhage); medications (corticosteroids, epinephrine); post-splenectomy.
- Clinical Significance of Low Counts: Severe thrombocytopenia (<50,000/µL) increases risk of spontaneous bleeding, including intracranial hemorrhage; moderate thrombocytopenia may lead to bleeding with trauma; mild reduction may be asymptomatic.
- Clinical Significance of High Counts: Primary thrombocytosis carries increased thrombotic risk; secondary increases usually resolve with treatment of underlying condition; very high counts may indicate platelet dysfunction.
- Factors Affecting Results: Medications, smoking status, exercise, stress, pregnancy, altitude, sample handling errors, clotting during collection, EDTA-induced pseudothrombocytopenia, platelet satellitism, hemolysis, and lipemia may affect results.
Associated Organs
- Primary Organ Systems Involved: Bone marrow (site of platelet production), spleen (platelet storage and destruction), liver (synthesis of thrombopoietin and clotting factors), kidneys (erythropoietin production affecting hematopoiesis), and cardiovascular system (platelet function in hemostasis).
- Diseases Associated with Abnormal Results: Leukemia and lymphomas, aplastic anemia, myelodysplastic syndromes, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia, immune thrombocytopenia (ITP), thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), lupus anticoagulant/antiphospholipid syndrome, hepatic cirrhosis, portal hypertension, systemic infections, HIV/AIDS, tuberculosis, drug-induced thrombocytopenia.
- Potential Complications from Abnormal Results: Severe thrombocytopenia: spontaneous bleeding, intracranial hemorrhage, gastrointestinal bleeding, hemoptysis, hematuria. Severe thrombocytosis: arterial or venous thrombosis, myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis. Both may impact surgical planning and anesthetic risk.
Follow-up Tests
- Additional Testing for Low Platelet Count: Peripheral blood smear, reticulocyte count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen level, D-dimer (for DIC evaluation), liver function tests, renal function tests, bone marrow biopsy/aspirate, antiplatelet antibody testing, HIV testing, hepatitis serology, thrombopoietin level, flow cytometry, anticardiolipin and anti-β2-glycoprotein antibodies (for antiphospholipid syndrome).
- Additional Testing for High Platelet Count: Peripheral blood smear, bone marrow biopsy, leukocyte alkaline phosphatase score, cytogenetic studies (BCR-ABL fusion gene for CML), JAK2 V617F mutation (for polycythemia vera and primary myelofibrosis), CALR and MPL mutations (for essential thrombocythemia), iron studies, inflammatory markers (ESR, CRP), reticulocyte count, hemoglobin electrophoresis, imaging studies if malignancy suspected.
- Monitoring Frequency: Patients on chemotherapy: weekly to monthly; patients with ITP undergoing treatment: weekly to monthly initially; patients with myeloproliferative disorders: every 3-6 months; patients on anticoagulation: initial and periodic monitoring; post-operatively: as indicated by clinical status.
- Complementary Tests: Complete blood count (hemoglobin, white blood cells, hematocrit), coagulation profile (PT, aPTT, thrombin time), bleeding time, platelet function analysis, von Willebrand factor levels and activity, factor VIII levels, thrombin generation assay, blood culture if infection suspected.
Fasting Required?
- Fasting Status: No - fasting is NOT required for platelet count testing. This test can be performed on a blood sample collected at any time, regardless of recent food or beverage consumption.
- Medications: Continue all routine medications unless specifically instructed otherwise by the healthcare provider. Inform the healthcare provider of all medications, supplements, and herbal products, as some may affect platelet count (NSAIDs, aspirin, anticoagulants, corticosteroids, antibiotics, anticonvulsants).
- Patient Preparation: No special preparation required. Patient may eat and drink normally. Wear loose, comfortable clothing to facilitate blood draw. Remain seated or lying down for several minutes before testing if prone to dizziness. Inform phlebotomist of any recent trauma, bleeding episodes, or bruising.
- Sample Collection: Blood sample collected via venipuncture into EDTA (lavender-top) tube. Sample processing should be timely to prevent artifact. Avoid prolonged tourniquet application and excessive fist clenching during collection.
- Special Considerations: Obtain results within 4 hours of collection. Avoid contamination with other anticoagulants. If pseudothrombocytopenia is suspected (from clumping), citrate tube may be used for confirmation. Platelet count may vary with time of day (circadian rhythm), physical stress, or recent medications.

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