Thrombocytosis - "But Don't Worry"

Immediately after my happy, happy time at the wig-fitting, I came crashing back down with a message from Dr. Cohen. "No emergency," he said on my voice mail. "Just checking in with you about the results of your lab tests last week."

What did that mean?? If everything was fine, why didn't he just say everything was fine? I was a little jittery until he called back, despite a friend, my husband, and my mother all telling me that it is normal for a doctor to call with the results, whatever they are, and that of course Dr. Cohen couldn't leave the details of the results in a voice mail. They probably have rules against that, for patient privacy. Okay, okay, but AARRGGHH!

Anyway, my complete blood count (CBC, which I'll be doing before every chemo session) showed normal levels of red and white blood cells, but elevated platelet levels. I also had elevated platelet levels while pregnant with Finn, but by taking iron supplements I was able to lower it to the high end of the normal range. I was supposed to go back for another CBC a few months after his birth to get a better baseline, but I was lazy (I mean, hey, I feel perfectly fine) and then all this stuff happened.

Elevated platelets can be bad because you could develop blood clots more easily. Conversely, if the platelets are high because they are defective, you could also hemorrhage. My counts weren't off the charts high, but were high enough to get Dr. Cohen's attention. The most likely reason is thrombocytosis, which can either be reactive or essential. Mine is most likely reactive both times, first to the pregnancy and now to the surgeries (this CBC was done about 1 1/2 weeks after my second lumpectomy, and platelets rise because of infection or inflammation, the latter of which is a obviously common effect of surgery). If fact, Dr. Cohen said that he wouldn't have thought twice about it had he not already known about my earlier elevated levels during pregnancy, which raises the possibility that my counts are just high all the time. (By the way, iron supplements are not recommended during chemo, so I can't treat it that way this time.)

The plan is to forge ahead with the chemo and radiation and then follow up with the platelet stuff. Of course, all these levels will be monitored closely throughout my chemo. If the platelets are still high after the chemo, Dr. Cohen wants to do a bone marrow biopsy to see if there is some reason why my bone marrow overproduces platelets. Essential thrombocytosis is what's called a "diagnosis of exclusion," meaning that if they can't find any other reason for the symptoms (high platelets), it must be that. This is a pretty unusual diagnosis in someone my age (average age at diagnosis is 60), but as we've discovered lately, such things do happen. All this could be possibly related or lead to a rarer form of leukemia (also seen primarily in older patients), but outside of that unlikelihood, Dr. Cohen assured me that essential thrombocytosis can be managed with medication if the levels get really high, and that, anyway, there is no evidence that this diagnosis lowers your life expectancy at all.

Great. Just another thing to worry about. Or not worry about, since we're not going to do anything about it until after the bc treatments. But a bone marrow biopsy doesn't sound fun, so let's hope for reactive thrombocytosis with platelet levels that soon fall back into the normal range.