Connection Between Thrombocytosis and POTS

Pathophysiological Mechanisms Linking Platelets and POTS

Reactive thrombocytosis is common in conditions with chronic inflammation, which may be relevant as POTS has been characterized as having a proinflammatory state, according to the Annals of the Rheumatic Diseases 1

POTS is diagnosed when there is an increase in heart rate ≥30 bpm (or ≥40 bpm in patients aged 12-19 years) within 10 minutes of standing without orthostatic hypotension, as recommended by the American Academy of Pediatrics and other medical societies 2
Common symptoms include dizziness, light-headedness, weakness, fatigue, palpitations, tremor, and blurred vision, affecting patients with POTS 2
Different POTS phenotypes have been identified, including hypovolemic, neuropathic, and primary hyperadrenergic POTS, representing different pathophysiological mechanisms, according to medical guidelines 3
When evaluating patients with suspected POTS and thrombocytosis, clinicians should consider complete blood count with platelet count and morphology, as suggested by the Annals of the Rheumatic Diseases 1

POTS is frequently associated with hypermobile Ehlers-Danlos syndrome (hEDS), with studies showing 25-37.5% of patients with hEDS reporting a diagnosis of POTS, according to medical research 2
Up to 40% of patients with POTS may self-report a viral upper respiratory or GI infection as the precipitating event to their symptoms, which could trigger both inflammatory responses and reactive thrombocytosis, as reported in Clinical Gastroenterology and Hepatology 4

For patients with both POTS and thrombocytosis, management should address both conditions, including treating the underlying cause of thrombocytosis if secondary, as recommended by the Annals of the Rheumatic Diseases 1