Severe Thrombocytosis in a Patient with Pulmonary Tuberculosis: A Case Report
Keywords:
Thrombocytosis, Tuberculosis, Pulmonary, Platelet, ImmunologyAbstract
Platelets are key players in the immunopathology of pulmonary tuberculosis (TB), and thrombocytosis is a rare complication of the disease. Thrombocytosis is defined as platelet counts exceeding 450 x 109/L. In TB, thrombocytosis is associated with other hematological changes and an increased risk of venous thromboembolism (VTE). An 80-year-old Chinese gentleman presented with a chronic cough for 2 weeks, without fever, weight loss, night sweats, family history of blood dyscrasia, or prior thrombotic events. Full blood count (FBC) showed leukocytosis with high white blood cells (WBC) (22.63 x 103/uL), neutrophils (19.49 x 103/uL), and platelets (1808 x 109/L). Peripheral blood film (PBF) showed leukocytosis with neutrophilia, monocytosis, and basophilia. Red blood cells (RBC) showed microcytic hypochromic anemia, and platelets were grossly increased with circulating megakaryocyte fragments. Essential thrombocytosis was suspected based on persistent thrombocytosis (normal range 150–450 x 109/L) for 1 week during admission; however, JAK2 mutation analysis was negative. Suspicion of pulmonary TB due to cough was confirmed via Gene-Xpert MTB/RIF sputum test (PCR). Subsequently, anti-tuberculosis therapy was initiated, and the patient responded well. The patient’s platelet count was monitored, but the patient was not on any VTE prophylaxis. Platelets may directly sense Mycobacterium tuberculosis (M. tuberculosis). As a rapid innate immune response, platelets become activated and granulated, releasing pro-inflammatory cytokines. Platelets then undergo structural changes and upregulate platelet-activated gene transcripts. Tissue damage in TB results from platelet interactions with other leukocytes, which produce matrix metalloproteinases (MMPs) and cytokines such as Interleukin-10 (IL-10) that inhibit the host immune response. Conclusion: There should be a high index of suspicion for TB infection in patients presenting with respiratory symptoms and severe thrombocytosis, especially in older patients. Antiplatelet therapy may be considered alongside the standard antitubercular drug regimen as a potential host-directed therapy to improve outcomes and prevent VTE complications in patients with pulmonary TB and severe thrombocytosis.
References
[1] World Health Organization: WHO & World Health Organization: WHO. (2023, November 7). Tuberculosis. https://www.who.int/news-room/fact-sheets/detail/tuberculosis
[2] Rokkam VR, Kotagiri R. Secondary Thrombocytosis [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560810/
[3] Zulkafli Z, Janaveloo T, Ab Rahman WSW, Hassan MN, Abdullah WZ. Extreme Thrombocytosis in a Child: Laboratory Approaches and Diagnostic Challenges. Oman Medical Journal. 2019 Jul 20;34(4):336–40.
[4] Angesom Gebreweld, Temesgen Fiseha, Kebede E, Tamir Z, Gebremariam B, Fikadu Miruts, et al. Immuno-Hematological and Biochemical Changes in Patients with Tuberculosis in Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. Journal of Blood Medicine [Internet]. 2024 Mar 1 [cited 2024 Oct 9];Volume 15:147–55. Available from: https://www.dovepress.com/immuno-hematological-and-biochemical-changes-in-patients-with-tubercul-peer-reviewed-fulltext-article-JBM
[5] Şahin F, Yazar E, Yıldız P. Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis. Multidisciplinary respiratory medicine. 2012 Dec;7:1-7.
[6] Lee MY, Kim YJ, Lee HJ, Cho SY, Park TS. Mean platelet volume in Mycobacterium tuberculosis infection. BioMed Research International. 2016;2016(1):7508763.
[7] Kutiyal AS, Gupta N, Garg S, Hira HS. A study of haematological and haemostasis parameters and hypercoagulable state in tuberculosis patients in northern India and the outcome with anti-tubercular therapy. Journal of clinical and diagnostic research: JCDR. 2017 Feb;11(2):OC09.
[8] Kirwan DE, Chong DL, Friedland JS. Platelet activation and the immune response to tuberculosis. Frontiers in Immunology. 2021 May 19;12:631696.
[9] Fox K, Kirwan DE, Whittington A, Krishnan N, Gilman RH, López JW, et al. Platelets Regulate Pulmonary Inflammation and Tissue Destruction in Tuberculosis. American Journal of Respiratory and Critical Care Medicine. 2018 Jul 15;198(2):245–55.
[10] Cox DJ, Keane J. Platelets and Tuberculosis: Small Cells, Not So Innocent Bystanders. American Journal of
Respiratory and Critical Care Medicine. 2018 Jul 15;198(2):153–4.
[11] Mwilitsa, E., Kimoloi, S., & Raballah, E. (2024). Hematological profiles of newly diagnosed pulmonary tuberculosis patients in Western Kenya. International Journal Of Community Medicine And Public Health, 11(6), 2225–2233. https://doi.org/10.18203/2394-6040.ijcmph20241480
[12] Mani S, Karampudi D. Reactive Thrombocytosis in Tuberculosis [Internet]. [cited 2024 Oct 9]. Available from: https://jcdronline.org/admin/Uploads/Files/65259182d98b51.56439559.pdf
[13] Shah AR, Desai KN, Maru AM. Evaluation of hematological parameters in pulmonary tuberculosis patients. Journal of family medicine and primary care. 2022 Aug 1;11(8):4424-8.
[14] Garg B. Reactive thrombocytosis-etiology and its relationship with different hematological parameters, ESR, & CRP in Tuberculosis. Inflammation (non-tuberculosis).;47:9-4.
[15] Angesom Gebreweld, Temesgen Fiseha, Kebede E, Tamir Z, Gebremariam B, Fikadu Miruts, et al. Immuno-Hematological and Biochemical Changes in Patients with Tuberculosis in Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. Journal of Blood Medicine [Internet]. 2024 Mar 1;Volume 15:147–55. Available from: https://www.dovepress.com/immuno-hematological-and-biochemical-changes-in-patients-with-tubercul-peer-reviewed-fulltext-article-JBM
[16] Maru A, Shah A, Desai K. Evaluation of hematological parameters in pulmonary tuberculosis patients. Journal of Family Medicine and Primary Care. 2022;11(8):4424.
[17] Masooma Jaffer, Omar Shahid, Rumaisha Aslam, Fatima Saeed, Atiqa Arshad, Muhammad Touqeer Hanif. Frequency of different causes of thrombocytosis among patients presenting to tertiary care hospital. The Professional Medical Journal [Internet]. 2024 Apr 1 [cited 2024 Oct 9];31(04):581–7. Available from: https://theprofesional.com/index.php/tpmj/article/view/7981
[18] Batool Y, Pervaiz G, Arooj A, Fatima S. Hematological manifestations in patients newly diagnosed with pulmonary tuberculosis. Pakistan Journal of Medical Sciences. 2022 Sep;38(7):1968.
[19] Kumarihamy K, Ralapanawa D, Jayalath W. A rare complication of pulmonary tuberculosis: a case report. BMC
Research Notes [Internet]. 2015;8(1):39. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4328059/
[20] Mckinnon A, Madua M. Pulmonary tuberculosis as a contemporary risk factor for pulmonary embolism. Case Report 1 African Journal of Respiratory Medicine [Internet]. 2024 [cited 2024 Oct 9];19. Available from: https://www.africanjournalofrespiratorymedicine.com/articles/pulmonary-tuberculosis-as-a-contemporary-risk-factor-for-pulmonary-embolism.pdf
[21] Lee MR, Lee MC, Chang CH, Liu CJ, Chang LY, Zhang JF, et al. Use of Antiplatelet Agents and Survival of Tuberculosis Patients: A Population-Based Cohort Study. Journal of Clinical Medicine [Internet]. 2019 Jun 27 [cited 2024 Oct 9];8(7):923–3. Available from: https://www.mdpi.com/2077-0383/8/7/923.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Journal of Biomedical and Clinical Sciences (JBCS)
This work is licensed under a Creative Commons Attribution 4.0 International License.
JBCS Publication Ethics
JBCS is committed to ensure the publication process follows specific academic ethics. Hence, Authors, Reviewers and Editors are required to conform to standards of ethical guidelines.
Authors
Authors should discuss objectively the significance of research work, technical detail and relevant references to enable others to replicate the experiments. JBCS do not accept fraudulent or inaccurate statements that may constitute towards unethical conduct.
Authors should ensure the originality of their works. In cases where the work and/or words of others have been used, appropriate acknowledgements should be made. JBCS do not accept plagiarism in all forms that constitute towards unethical publishing of an article.
This includes simultaneous submission of the same manuscript to more than one journal. Corresponding author is responsible for the full consensus of all co-authors in approving the final version of the paper and its submission for publication.
Reviewers
Reviewers of JBCS treat manuscripts received for review as confidential documents. Therefore, Reviewers must ensure the confidentiality and should not use privileged information and/or ideas obtained through peer review for personal advantage.
Reviews should be conducted based on academic merit and observations should be formulated clearly with supporting arguments. In cases where selected Reviewer feels unqualified to review a manuscript, Reviewer should notify the editor and excuse himself from the review process in TWO (2) weeks time from the review offer is made.
In any reasonable circumstances, Reviewers should not consider to evaluate manuscripts if they have conflicts of interest (i.e: competitive, collaborative and/or other connections with any of the authors, companies, or institutions affiliated to the papers).
Editors
Editors should evaluate manuscripts exclusively based on their academic merit. JBCS strictly do not allow editors to use unpublished information of authors without the written consent of the author. Editors are required to take appropriate responsive actions if ethical complaints have been presented concerning a submitted manuscript or published paper.
CONFLICT OF INTEREST
Journal of Biomedical and Clinical Sciences requires authors to declare all competing interests in relation to their work. All submitted manuscripts must include a ‘competing interests section at the end of the manuscript listing all competing interests (financial and non-financial). Where authors have no competing interests, the statement should read ,The authors have declared that no competing interests exist. Editors may ask for further information relating to competing interests.
Editors and reviewers are also required to declare any competing interests and will be excluded from the peer review process if a competing interest exists. Competing interests may be financial or non-financial. A competing interest exists when the authors interpretation of data or presentation of information may be influenced by their personal or financial relationship with other people or organizations. Authors should disclose any financial competing interests but also any non-financial competing interests that may cause them embarrassment if they were to become public after the publication of the article.
HUMAN AND ANIMAL RIGHTS
All research must have been carried out within an appropriate ethical framework. If there is suspicion that work has not taken place within an appropriate ethical framework, Editors will follow the Misconduct policy and may reject the manuscript, and/or contact the author(s) institution or ethics committee. On rare occasions, if the Editor has serious concerns about the ethics of a study, the manuscript may be rejected on ethical grounds, even if approval from an ethics committee has been obtained.
Research involving human subjects, human material, or human data, must have been performed in accordance with the Declaration of Helsinki and must have been approved by an appropriate ethics committee. A statement detailing this, including the name of the ethics committee and the reference number where appropriate, must appear in all manuscripts reporting such research. Further information and documentation to support this should be made available to Editors on request.
Experimental research on vertebrates or any regulated invertebrates must comply with institutional, national, or international guidelines, and where available should have been approved by an appropriate ethics committee. The Basel Declaration outlines fundamental principles to adhere to when conducting research in animals and the International Council for Laboratory Animal Science (ICLAS) has also published ethical guidelines.
A statement detailing compliance with relevant guidelines (e.g. the revised Animals (Scientific Procedures) Act 1986 in the UK and Directive 2010/63/EU in Europe) and/or ethical approval (including the name of the ethics committee and the reference number where appropriate) must be included in the manuscript. The Editor will take account of animal welfare issues and reserves the right to reject a manuscript, especially if the research involves protocols that are inconsistent with commonly accepted norms of animal research. In rare cases, Editors may contact the ethics committee for further information.
INFORMED CONSENT
For all research involving human subjects, informed consent to participate in the study should be obtained from participants (or their parent or guardian in the case of children under 16) and a statement to this effect should appear in the manuscript, this includes to all manuscripts that include details, images, or videos relating to individual participants.
DATA SHARING POLICY
JBCS strongly encourages that all datasets on which the conclusions of the paper rely should be available to readers. We encourage authors to ensure that their datasets are either deposited in publicly available repositories (where available and appropriate) or presented in the main manuscript or additional supporting files, in machine-readable format (such as spreadsheets rather than PDFs) whenever possible
Authors who do not wish to share their data must state that data will not be shared, and give the reason.
COPYRIGHT NOTICE
The JBCS retains the copyright of published manuscripts under the terms of the Copyright Transfer Agreement. However, the journal permits unrestricted use, distribution, and reproduction in any medium, provided permission to reuse, distribute and reproduce is obtained from the Journal's Editor and the original work is properly cited.
While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Copyright (c) 2023 Journal of Biomedical and Clinical Sciences (JBCS)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
