Although thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. Diagnostic value of postoperative platelettowhite blood. Fatal pulmonary embolism following splenectomy in a patient with. Thrombocytosis high platelets about thrombocytosis thrombocytosis is an increase in platelets 600 x 109l, commonly found incidentally in a routine blood test.
The platelet count has become a variable of great interest for physicians working in the intensive care unit icu. Reactive thrombocytosis, the most common cause of thrombocytosis, can be expected in. A 20yearold male who required splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. Post splenectomy syndrome can occur after surgery to remove the spleen. In hereditary spherocytosis with severe anemia, splenectomy is a recommended treatment. Postsplenectomy thrombocytosis with pseudohyperkalaemia. The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Haemostasis rarely affected prv, et, myelofibrosis, may. This topic discusses our approach to the adult or child with unexplained thrombocytosis. One of the functions of the spleen is to help filter out impurities and worn out blood components, including red blood cells and platelets.
Reactive thrombocytosis is a predictable finding after splenectomy, with the platelet count peaking at 1 to 3 weeks and. The platelet count in reactive thrombocytosis is expected to normalize after resolution of the underlying condition. Acute myocardial infarction in a patient with post. The spleen plays a major role in platelet regulation, as it is the primary site of destruction of platelets, which is why thrombocytosis is seen with hyposplenism 7,8. Lifethreatening hypercoagulable state following splenectomy. The platelet count in reactive thrombocytosis is expected to normalize after. It may develop immediately or as late as 65 years post splenectomy 24. Postsplenectomy thrombocytosis is a complication of splenectomy about which there is little published information. Essential thrombocytosis 40 years after splenectomy bmj case. Mild thrombocytosis may be observed after a splenectomy due to the lack of sequestering and destruction of platelets that would normally be carried out by the spleen. Unlike essential thrombocytosis, which is associated with thrombotic and hemorrhagic complications, reactive thrombocytosis rt is usually considered a benign process without thrombotic. Myocardial infarction complicating post splenectomy thrombocytosis, with early left ventricular mural thrombus formation and cerebral embolism. Click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Splenectomy, hyposplenism and asplenia information page patient.
The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. A coiisidcration of thc nicchanisni of post splenectomy thrombocytosis and its possible bearing on post splenectomy thromboembolism forms the basis of this report. Thromboembolic risk of postsplenectomy thrombocytosis. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and. Download ebook tumor immunology and cancer vaccines pdf free. The first documented splenectomy was performed in 1549 to remove a symptomatic enlarged spleen.
Reactive thrombocytosis after coronary bypass surgery. Even though the platelet count is elevated for a short time or even indefinitely after splenectomy, secondary thrombocytosis does not typically lead to abnormal blood clotting. Postsplenectomy thrombocytosis is a known postoperative complication that has been reported by many authors. Similarly, in patients with extreme thrombocytosis, reactive thrombocytosis is a more common cause of thrombocytosis than primary or essential thrombocytosis. Reactive thrombocytosis rt has earlier been reported to occur as aresponse to various situations and conditions, such as post splenectomy,hematopoietic disorders, major trauma and operations. Postoperative thrombocytosis jama internal medicine. Similarly, in patients with extreme thrombocytosis, reactive thrombocytosis is a more common cause of thrombocytosis than primary or. Lifetime reactive thrombocytosis may also be present in patients who have had a splenectomy. Thrombosis in association with elevated platelet count after splenectomy is well.
Results rt platelets500x109 occurred after the 7th postsplenectomy day in both patients. Reactive thrombocytosis, the most common cause of thrombocytosis, can be expected in postsplenectomy states. This website provides free medical books this website provides over 0 free medical books and more for all students and doctors this website the best choice for medical students during and after learning medicine. Overwhelming postsplenectomy infection opsi is a serious disease that. The major longterm complication of splenectomy is opsi, also known as postsplenectomy sepsis syndrome, which is defined as a generalized nonspecific flu. Postsplenectomy and hyposplenic states antonio di sabatino, rita carsetti, gino roberto corazza the spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive. However, the spleen carries an important role both in immune function and coagulation. A rare case of triplenegative essential thrombocythemia in a. Among experimental and clinical measures which are reported to raise the platelet count, surgical procedures, particularly splenectomy, have attracted much attention.
Casereports 533 theplatelet counthadfallen 1228x1091. Hitherto, most studies have focused on thrombocytopenia and the time course of changes in the platelet count in critically ill patients. Essential thrombocytosis there are 2 types of thrombocytosis. Overwhelming post splenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. Thromboembolic risk of postsplenectomy thrombocytosis jama. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. Introduction splenectomy induced thrombocytosis and leukocytosis may obscure the early diagnosis of post operative infection or sepsis. Essential thrombocytosis 40 years after splenectomy. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. Reactive thrombocytosis is the presence of a high platelet count in response to infection, trauma, or surgery. Pdf blood changes after splenectomy in portal hypertension.
His medical history was notable of splenectomy after a spleen rupture due to a car accident at the age of 25, a subarachnoidal haemorrhage sah without evidence of cerebral aneurysm at the age of 35 and a nonst elevation myocardial infarction at the age of 63. Complications of splenectomy surgical complications. Jan 14, 2015 thrombocytosis is defined as a platelet count above the upper limit of the normal range 450 x 10 9 l in adults this article aims to outline diagnosis, investigation and management of patients with thrombocytosis and to highlight possible complications. Thrombocytosis increased platelet count, which can cause blood. Splenectomy had been performed for centuries prior to the establishment of the spleens physiology and function. Reactive thrombocytosis is generally a selflimiting condition that resolves with the inciting condition. First, the rise in the platelet count is more difficult to rationalize than. In another study of 280 patients with a platelet count 1,000. A specific issue is represented by the occurrence of thrombocytosis following splenectomy in pmf. The symptoms resolved, and the findings returned to normal within three weeks. Acute central retinal vein occlusion secondary to reactive. Postsplenectomy thrombocytosis could therefore be dismissed as. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after.
If present, hypercoagulability could increase the risk for development of postsplenectomy thrombotic conditions such as portal system thrombosis and pulmonary thromboembolism. However, recognition and clinical management of opsi is not well established. Thrombocytosis and thrombosis hematology american society. Postsplenectomy reactive thrombocytosis request pdf. Reactive thrombocytosis is a predictable finding after splenectomy, with the platelet count peaking at 1 to 3 weeks and returning to normal levels in weeks, months, and, rarely, years.
Mortality is significant and reported to be as high as 50% 4,5. Clinical manifestations and diagnosis of specific causes of thrombocytosis are discussed separately. A 69yearold man presented at our department of neurology in december 2016 with acute aphasia. Postoperative thrombocytosis jama internal medicine jama. A rare case of triplenegative essential thrombocythemia. Secondary thrombocytosis subsides when the underlying process causing the elevated platelet count resolves treatment of infection, recovery from surgery, etc.
The patient was treated with steroids for papilledema and administered coumadin and aspirin. There is no evidence of an increased risk of thromboembolic disease but prophylactic aspirin may be considered for very high platelet counts. Splenectomy alone accounts for 19% of all possible causes of extreme thrombocytosis i. The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. To our knowledge, this retrospective study of 318 patients without myeloproliferative disorders who underwent splenectomy is the largest of its type. Vol 378 july 2, 2011 post splenectomy and hyposplenic states antonio di sabatino, rita carsetti, gino roberto corazza the spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and. Postsplenectomy syndrome can occur after surgery to remove the spleen. Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%. The first documented splenectomy was performed in 1549 to remove a. The effect of splenectomy on platelet formation and. As pointed out above, the combination of hyposplenism, b 12 replacement, and severe anemia could have precipitated extreme thrombocytosis in our patient. The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms.
Objective to determine whether the platelettowhite blood cell ratio can. The case of long undiagnosed pseudohyperkalaemia in an 84yearold lady with thrombocytosis post splenectomy is. Postsplenectomy thrombocytosis annals of internal medicine. Introduction splenectomyinduced thrombocytosis and leukocytosis may obscure the early diagnosis of postoperative infection or sepsis. The spleen plays a major role in platelet regulation, as it is the primary site of destruction of platelets, which is why thrombocytosis is seen with hyposplenism. Marked thrombocytosis and thromboelastography values suggestive of hypercoagulability were common during the first 2 weeks after splenectomy for the dogs of this study. Managing uncontrolled postsplenectomy reactive thrombocytosis.
The late, longlasting, minor thrombocytosis, which occurs after splenectomy but not after sham operation, can be explained by the removal of the splenic platelet pool. However, although pcrsistcnt postsplenectomy thrombocytosis has thus been recognized for many years, the underlying cause is poorly understood and has scldom bccn discussed. It consists of a group of symptoms and signs such as. However, one month later the count had risen to 2032x 1091.
This report illustrates the diagnostic problems associated with a refractory post splenectomy thrombocytosis, and the therapeutic difficulties in the management of primary thrombocythaemia are discussed. However, although pcrsistcnt post splenectomy thrombocytosis has thus been recognized for many years, the underlying cause is poorly understood and has scldom bccn discussed. Discussion the distinction between primary thrombocythae miaand areactive. Essential thrombocytosis 40 years after splenectomy bmj. The primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis.
Splenectomy alone accounts for 19% of all possible causes of extreme. A lifethreatening hypercoagulable state hcs is reported that developed after splenectomy in idiopathic thrombocytopenic purpura itp. Postoperative thrombocytosis and thromboelastographic. Pdf postsplenectomy thrombocytosis with pseudohyperkalaemia.
Recent studies have found that between 87% and 96% of people found to have platelet counts over 500, 000. Reactive thrombocytosis is the presence of high platelet count in response to infection, trauma, or surgery 4. This report illustrates the diagnostic problems associated with a. Postsplenectomy reactive thrombocytosis europe pmc. The distinction between primary and reactive thrombocytosis by bone marrow histology is very important. The post splenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Essential thrombocytosis pdf free pdf epub medical books. After the removal of the spleen, since there is a decreased recycling of the bodys platelets, there will normally be an increase in the number of circulating platelets, a socalled thrombocytosis. His medical history was notable of splenectomy after a spleen rupture due to a car. Postsplenectomy thrombocytosis and managements juniper. In trauma patients after splenectomy, a platelettowhite blood cell ratio of post operative sepsis from transient physiological responses.
The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. Postsplenectomy reactive thrombocytosis europe pmc article. Alesser degree ofthrombocytosis upto x1091 maypersist for longerperiods in patients whereanaemiacontinuesfollowing splenectomy hirsh and dacie, 1966. In trauma patients after splenectomy, a plateletto. Reactive thrombocytosis rt has earlier been reported to occur as aresponse to various situations and conditions, such as post splenectomy,hematopoietic disorders, major trauma and operations, neoplasms andinflammations. Primary thrombocythaemia following splenectomy postgraduate.
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