Can blood loss cause high platelet count? does platelets increase or decrease with bleeding?

Bleeding, blood loss due to injuries, trauma, after surgery, or as a consequence of chronic conditions. The reasons why the bleeding and blood loss causing the platelets to go up in the CBC blood test because when the body losing blood, it calls the hemostasis system to compensate the loss especially if you bleed too much, therefore, the body system elevates the count of platelets to compensate as a natural surviving action and not due to effect of the disease itself.

What could be happen in platelets if you injured?
When someone got injuries due to any reason, there’re three possible routes:
First: the injured person may have got one or plenty of wounds and/or bruises with simple short-time bleeding, in this case the bruises lead to high-normal level of platelets count (e.g. 380), or may appear elevated to a mild degree (e.g. 460), while the normal platelets count is (150-450), example for this is the scratches and small skin penetrations by needle or a shaving-blade.

Second: an injured person got wide wounds with too many bruises and long-time bleeding, in this case the blood loss and accompanied inflammation can cause platelets increase out of normal range (e.g. 485).

Third: someone who injured or has holes inside his gut for instance which may bleed too much for a longer period of time (weeks or months), in this case the open wound can cause uncontrolled blood loss, blood loss cause large consuming of blood cells and platelets which lead to low platelets count in the CBC test (e.g. 96,000)

Causes of high platelets count due to blood loss, injuries and bleeding

Below are some examples of blood loss situations that elevate platelets count in the blood count test

Road accidents
High platelets in a person who is a victim of a sudden road accidents. The blood platelet test may show an increase in the number of platelets, and that is for two reasons, the first is that there have been deep wounds that led to a big bleeding of blood, the second is that the patient has been exposed to large internal and external bruises that cause strong inflammations, which led to activation of all factors of the body’s defense against inflammatory agents including activation of blood platelets.

Gunshot wounds
Also the penetration caused by fire–weapons can lead to death and of course if the person still alive, the platelets may show mild elevated to due both severe inflammations and uncontrolled bleeding.

High platelets in abdominal pain and chronic internal bleeding (e.g. peptic ulcers)
The commonest source of upper gastrointestinal bleeding is the peptic ulcer in which thrombocytosis can appear as a secondary effect to upper gastrointestinal bleeding, GIT bleeding can be identified by endoscopic findings.
If Untreated Gastrointestinal bleeding “medical term is hemorrhage”, the body compensates the platelets by increasing production of platelets into the bloodstream up to extreme levels “e.g. more than 800,000”, but if the bleeding prolonged it will be hard to normalize the count of platelets and may out of control or platelets may deplete as a result of increasing blood loss and exhausted bone marrow, you shouldn’t worry if GIT bleeding treated well then the platelets count must go down to the normal levels, essential thrombocythemia is suspected if the platelets still elevated in a treated GIT patient.
Abdominal hemorrhage can be detected if you got blood in stool examination test with or without abdominal pain.

Case study:

  • Vomiting blood “medical term is hematemesis”, in which the patient expel blood from the mouth
  • Blood show up in the stool examination, black, tar–like, sticky stools which come from damage to the GI tract lining, prolonged bleeding then breakage of swollen blood vessels
  • Upper gastrointestinal endoscopy revealed multiple duodenal ulcers with active bleeding and neoplasms.
  • positive for a Helicobacter pylori infection

Laboratory tests revealed:
high WBC+High PLT+Low Hb, the elevated WBC count was 21.5 × 109/L (normal range: 3.5–9.5 × 109/L),
neutrophilia 90% (normal range: 40–75%),
the RBC count was 2.5 × 1012/L (normal range: 4.3–5.8 × 1012/L),
Hemoglobin hgb 6.3 g/dL (normal range: 13.0–17.5 g/dL),
Hemtocrit Hct 18.4% (normal range: 40–50%),
Platelets PLT count 914 × 109/L (normal range: 140–400 × 109/L), and
plateletcrit PCT 0.822 (normal range: 0.108–0.272).

The patient platelets count back to normal after receiving the appropriate treatment, thus the doctor rule out MPNs and consider the high platelets count is subsided after upper GIT bleeding.
Examples of bleeding that cause blood loss but may not elevate platelets level in the blood test:

Bruises or hematoma,
typically is a collection of blood outside of blood vessels, platelets accumulate and may form mild or serious clots as natural response, for instance, bruises that may appear as pinkish patches under the skin after drawing a blood sample by unexperienced person, but the platelets count in the drawn sample may or may not get elevated.

Scrapes, abrasions, lacerations (cuts), or crushing injuries,
if they don’t penetrate the skin too far the skin can seal the wounds without elevating the platelets above the normal levels.

Puncture wounds from items like needles, nails, or knives
considered simple wounds that can’t cause high platelets in the blood test unless they cause severe non–local inflammation.

Bleeding from inflammation due to bacteria infection
Yes, some bacterial infections are able to cause a wound and a wide spot of inflammation, which attracts a very large number of blood platelets and this may explain why we see a high platelet count in a blood count test in bacterial infections.

Bleeding after surgeries can elevate platelets count
As previously explained in this post “platelets count after spleen removal“, after surgeries the lab scientists notice sudden increase in count of blood platelets but shortly can back to normal limits, although the person might bleed too much during the surgical operation.

Autoimmune blood loss can raise platelets count

By this, we mean, that there are some diseases in which red blood cells broken down a lot more than usual, in this publication “why platelets count increase in case of sickle cells anemia?” an example of immune hemolysis that leads to an increase in the number of blood platelets outside the normal limit which left the affected person prone to bleeding.

Bleeding from breast cancers and uterine cancers can affect platelets level

You can read more on that there: Which cancers can cause platelets high count?

How to read and understand you lab test results?
If you have one or more causes of bleeding and blood loss and have had a complete blood count test, you may find some of these results in your lab report:

  1. Some codes can be used for annotation of abnormal results, for instance the letter “A” you can know what does the letters next to a lab result mean?
  2. “AGG” near of platelets count value can be a sign or wrong result which must be repeated,
  3. Understand the meaning of “platelets high H”
  4. What does “Platelets L” means?
  5. If you were asking what is the meaning of “MPV”? it means “mean platelets volume and help doctors to know the average size of platelets in the blood circulation.
  6. PDW value can help doctors know if the platelets in your blood is circulating in a good aggregations or not?

Dr.Megan Ralf

A Medical laboratory Scientist who devoted his life to medical and laboratory sciences, writes his everyday expertise dealing with various pathological conditions through laboratory diagnosis of different body fluids, also participating in many workshops for first aids, infection control, and urgent care. Also Dr Megan Ralf coaching many medical teams.

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