Assessment of procoagulant potential in patients with reactive thrombocytosis and its association with platelet count

Amihai Rottenstreich, Ela Shai, Geffen Kleinstern, Galia Spectre, David Varon, Yosef Kalish

Research output: Contribution to journalArticlepeer-review


Objective: We aimed to determine hemostatic changes and characterize the procoagulant potential among patients with reactive thrombocytosis (RT). Methods: Sixty patients with RT (median platelet count 718 × 109/L) and 20 healthy persons were tested for complete blood count, C-reactive protein, von Willebrand factor (VWF), factor VIII and fibrinogen, and thrombin generation. Platelet studies, including light transmission aggregometry and Cone and Plate(let) Analyzer, were also conducted. Reticulated platelets and platelet P-selectin expression were measured using flow cytometry. Results: Compared to patients with mild thrombocytosis (platelet count 500-700 × 109/L; n = 27), those with moderate-to-severe thrombocytosis (platelet count >700 × 109/L; n = 33) had significantly higher fibrinogen, factor VIII, and VWF antigen and activity levels; higher endogenous thrombin potential, peak thrombin generation and velocity index levels, and shorter time-to-peak thrombin level. VWF antigen and activity, fibrinogen, and factor VIII were positively associated with platelet count, whereas VWF activity/antigen ratio was inversely correlated. In a multivariate analysis of RT and control participants, only platelet count predicted endogenous thrombin potential with a positive-linear correlation. No patients developed acquired von Willebrand syndrome. Conclusions: As determined by thrombin generation, RT was associated with in vitro prothrombotic tendency, which correlated with platelet count. This may explain the increased thromboembolic risk previously reported in patients with RT.

Original languageEnglish
Pages (from-to)286-293
Number of pages8
JournalEuropean Journal of Haematology
Issue number3
StatePublished - Mar 2018
Externally publishedYes

Bibliographical note

Funding Information:
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local institutional review board of Hadassah Medical Center Helsinki Committee (IRB approval number No. HMO 0550-16).

Publisher Copyright:
© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd


  • hypercoagulable state
  • platelet count
  • reactive thrombocytosis
  • secondary thrombocytosis
  • thrombin generation

ASJC Scopus subject areas

  • Hematology


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