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