Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%. Even though thrombocytosis is benign and selflimiting in most cases, it can result in hemorrhage or. Accordingly thrombocytosis is reported to be observed in. Thrombocytosis is frequently encountered as an incidental laboratory finding. The prevalence, natural history, and implications of reactive thrombocytosis after liver transplantation lt are unknown. Without guidelines or randomized trials directing evidencebased use of anticoagulation, we must rely on case series and case studies. The only pathological finding was a thrombocytosis of 1700. The authors conclude that post splenectomy thrombocytosis is not associated with an increased risk for hemostatic complications 20. Anytime after splenectomy lifetime increase in risk for fatal pna, sepsis higher risk after splenectomy for malignancy. Reactive thrombocytosis is a much more frequent cause of thrombo cytosis than autonomous thrombocytosis even when cases. Oct 25, 2019 reactive thrombocytosis rt, platelets. Both the platelet count at 1 week and 1 month after the operation p thrombocytosis at 1 week and 1 month p thrombocytosis after splenectomy 6. The platelet count is thought to rise rapidly following splenectomy, with some authors reporting almost invariable thrombocytosis within 710 days. Postoperative thrombocytosis and thromboelastographic.
However, previous thrombocyte levels as documented during the sah and during routine assessments had been below 840. Postsplenectomy, itp should be considered as a thrombophilic condition and. Reactive secondary thrombocytosis is characterized with elevated platelet count in response to infections, trauma, occultmalignancy,surgery,myeloproliferativedisorders,and splenectomy. Splenectomy alone accounts for 19% of all possible causes of extreme thrombocytosis i. It occurred in 41% of splenectomy patients, but only 6% of nonop patients. Some case reports and studies have shown that post crs and hipec, there is fluctuation in platelet level temporarily but persistent thrombocytosis in a case of pmp post cytoreductive surgery and hipec is rare. 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. Thromboembolic risk of postsplenectomy thrombocytosis. The diagnosis and treatment of central retinal vein occlusion was reported in a young patient. Conclusion reactive thrombocytosis can occur post splenectomy but. This patient has target cells, acanthocytes and spherocytes with a mild thrombocytosis. Platelets are blood cells in plasma that stop bleeding by sticking together to form a clot.
Objectives to evaluate the clinical outcome and complications in the pediatric population who had splenectomy at our institution, emphasizing the incidence of postplenectomy reactive thrombocytosis rt and its clinical significance in children without underlying hematological malignancies. Postsplenectomy response in adult patients with immune. The phenomenon of temporary leukocytosis following splenectomy has been well known for many decades as a physiologic response to the removal of the spleen. How is thrombocytosis managed following splenectomy for. Systemic thromboembolic complications after laparoscopic. A20yearold malewhorequired splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. Prophylactic administrations of aspirin for the prevention of thrombo. Primary immune thrombocytopenia itp is an acquired bleeding disorder characterized. The same combination leads to an augmented leukocytotic response. It is most common in patients with massive splenomegaly from myeloproliferative disorders.
Impact of splenectomy on postsurgical platelet count. Reactive thrombocytosis can occur post splenectomy but usually transient. In trauma patients after splenectomy, a platelettowhite blood cell ratio of post operative sepsis from transient physiological responses. Ellman l 1978 thromboembolic risk of postsplenectomy thrombocytosis. A patient with secondary, or reactive, thrombocytosis. The overall thrombosis rate was significantly lower in patients who received an extended thromboprophylaxis course following splenectomy 3. This topic discusses our approach to the adult or child with unexplained thrombocytosis. While it is known that platelet counts frequently increase post splenectomy, the exact timing of the increase, as well as how much of an increase is expected based on the diagnosis at splenectomy has not been systematically studied. The most common etiology is reactive secondary thrombocytosis due to infections, trauma, surgery, or occult malignancy. Fatal pulmonary embolism following splenectomy in a. Patient tpo receptor agonist platelets before splenectomy. Thrombocytosis high platelets about thrombocytosis thrombocytosis is an increase in platelets 600 x 109l, commonly found incidentally in a routine blood test.
Diagnostic value of postoperative platelettowhite blood. Introduction splenectomy induced thrombocytosis and leukocytosis may obscure the early diagnosis of post operative infection or sepsis. Thrombocytosis definitionpage contents1 thrombocytosis definition2 thrombocytosis icd9 code3 thrombocytosis types4. Severe thrombocytosis, which was not present prior to splenectomy, was noted, and a diagnosis of reactive thrombocytosis was initially made. Due to its large vascular mass, the spleen contains up to of the total platelet mass. However, antiplatelet agents may be of benefit in patients with extreme thrombocytosis 1,500 gl particularly if there are additive cardiovascular risk factors 22. Extreme thrombocytosis after pediatric pancreatectomy with. Thromboembolic risk of postsplenectomy thrombocytosis jama. Her post splenectomy platelet count was 227 x 106ml which elevated to 1623 x 106ml on the. Case report acute central retinal vein occlusion secondary to. Read and find out all about this condition, including its primary causes, symptoms, treatment options, prognosis and more.
The thrombocytosis was assumed to be an unusually marked reactive response following trauma and splenectomy and was expected to subside rapidly. 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. Case report acute central retinal vein occlusion secondary. 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. Impact of splenectomy on postsurgical platelet count blood. Essential thrombocytosis 40 years after splenectomy bmj case. There is a wide range of primary and secondary causes as well as false or spurious. If present, hypercoagulability could increase the risk for development of postsplenectomy thrombotic conditions such as portal system thrombosis and pulmonary thromboembolism. Vascular complications after splenectomy for hematologic. A singlesite, retrospective, observational cohort study of patients who underwent total splenectomy between 2010 and 2018 was performed.
Fatal pulmonary embolism following splenectomy in a patient. Theplatelet count routinely increases at least 30% after splenectomy, and postsplenectomy thrombocytosis is a common finding. The goal of the subsequent discussion is to investigate burden of. Thrombocytosis refers to having too many platelets in your blood. They found platelet counts greater than 370,000 in onethird of post splenectomy patients persisting as long as. L often occurs postoperatively, similar to other postsplenectomy states, but the degree of similarities and true incidence are unknown. Managing uncontrolled postsplenectomy reactive thrombocytosis. Since the incidence of postsplenectomy reactive thrombocytosis is cited at 7582% and the incidence of thrombosis associated with it is approximately 5%. Thrombocytosis causes, symptoms, treatment, prognosis and. Patients who relapse after splenectomy may respond to subsequent medical therapies, and stable platelet counts can be achieved in most individuals23. Oral salicylate therapy was, however, started as prophylaxis against possible thrombotic compli. To our knowledge, this retrospective study of 318 patients without myeloproliferative disorders who underwent splenectomy is the largest of its type. Although dvt and pe occurred in these patients 8%, which seems a bit high, there was no association with thrombocytosis, extreme thrombocytosis, or aspirin use. Since the incidence of postsplenectomy reactive thrombocytosis is cited at 7582% and the incidence of thrombosis associated with it is approximately 5%, depending on other associated risk.
Nov 29, 2018 removal of the spleen can lead to reactive thrombocytosis, with an incidence of approximately 75% to 82%. Persistent thrombocytosis in a case of pseudomyxoma peritonea. With secondary thrombocytosis, the platelet count is usually aug 01, 2020. With secondary thrombocytosis, the platelet count is usually aug 01, 2020 background. Too many platelets can lead to certain conditions, including stroke, heart attack or a clot in the blood vessels. Case report balancing therapy with thrombopoietin receptor. Apr 06, 2021 thrombocytosis in the face of splenectomy rarely requires treatment.
Inflammation or infection, surgery, especially splenectomy removal of the spleen. Essential thrombocytosis 40 years after splenectomy. Reactive thrombocytosis is a predictable finding after. Some drugs, such as vincristine, are used to treat immunemediated thrombocytopenia because they stimulate platelet production.
Postsplenectomy thrombocytosis and managements juniper. A group of complications that occur after splenectomy. Clinical manifestations and diagnosis of specific causes of thrombocytosis are discussed separately. Thromboembolic complications after splenectomy for. Hyperfunctioning platelets in the thrombocytotic patients after major surgery were. Reactive thrombocytosis is a much more frequent cause of thrombo. Secondary thrombocytosis is the term for a condition that results in very high platelet counts in the blood in reaction to another problem in the patients body, such as inflammatory disease, removal of the spleen, or iron deficiency in adults. Thrombocytosis represents a platelet count over 500. The aim of this study is to evaluate the frequency and gravity of reactive thrombocytosis in pediatric patients who underwent splenectomy. Thromboembolic complications after splenectomy for hematologic. Thromboembolic complications after splenectomy 145. L, aspirin 65 mg daily may be considered to minimize the rare development of stroke or thrombosis see treatment. Other causes of thrombocytosis, such as reactive thrombocytosis or inflammatory diseases or autoimmune or paraneoplastic thrombocytosis, have. Over the next 10 days the platelet countroseprogressively to 3472x1091.
Marked thrombocytosis and thromboelastography values suggestive of hypercoagulability were common during the first 2 weeks after splenectomy for the dogs of this study. Jul 27, 2016 extreme thrombocytosis counts 1mul occurred in 25 patients 16%. Central retinal vein occlusion was probably related to secondary to reactive thrombocytosis after splenectomy. Overall, 73 patients 88% had an initial response after splenectomy. Before splenectomy, there was a positive correlation between platelet density and. Peripheral blood film from a patient showing post splenectomy changes. Response to splenectomy was better in young patients and in those patients who had higher immediate postsplenectomy thrombocytosis. Splenectomy and thrombocytosis find, read and cite all the research you need on researchgate. Thrombocytosis is a physiologic response to splenectomy. Longterm complications of splenectomy in adult immune throm. It is important for physicians to be familiar with the complications associated with thrombocytosis.
Prospectively collected data from july 2000 to february 2006 were analyzed. Influence of splenectomy on platelet morphometry and function. Hematologic trends after pancreatectomy with islet autotransplantation iat, which involves splenectomy, have been rarely studied. Of the 20 clonal thrombocytosis, the most common disorder was essential thrombocythemia. A 20yearold male who required splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. Materials and methods the medical records of pediatric patients undergoing splenectomy were. Postsplenectomy reactive thrombocytosis request pdf. Extreme thrombocytosis may result in thrombotic events such as acute myocardial infarction, mesenteric vein thrombosis, and pulmonary embolism. In 1977, a casecontrol study of 745 world war ii servicemen who had splenectomy resulting from trauma demonstrated that they were 1. Managing uncontrolled postsplenectomy reactive thrombocytosis in. Reactive thrombocytosis is the presence of a high platelet count in response to infection, trauma, or surgery. 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.
Clinical course and shortterm outcome of postsplenectomy reactive. In normal patients post splenectomy reactive thrombocytosis does not need any treatment inspite of high thrombocyte count in 70 to 80 percent of case. Persistent thrombocytosis in a case of pseudomyxoma. Aug 14, 2017 post splenectomy thrombocytosis was not associated with thrombosis p 0. Therefore, confusion exists as to whether postsplenectomy leukocytosis should be considered a. A patient with secondary, or reactive, thrombocytosis should have a return to normal. Secondary, or reactive, thrombocytosis is caused by another condition the patient may be suffering from, such as.
However, treatment of infection and iron deficiency should be treated. Request pdf on feb 1, 2008, farzal anwar and others published sickle cell disease. Case reports of thrombocytosis following splenectomy for refractory itp treated with tpora preoperatively. Thrombocytosis manifesting subsequently can be medically managed with drug therapy. Although thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. For patients with platelet counts in excess of 1,000,000. In one study, 75% of individuals without myeloproliferative disorders developed thrombocytosis after splenectomy 5. The symptoms resolved, and the findings returned to normal within three weeks.
Acute central retinal vein occlusion secondary to reactive. The patient was treated with steroids for papilledema and administered coumadin and aspirin. Guideline for investigation and management of adults and. Itp who developed postsplenectomy reactive thrombocytosis.
Severe or persistent postsplenectomy thrombocytosis may be a result of. Further evidences focusing on management of thrombotic complications in itp patients, post splenectomy are awaited. The platelet counts after splenectomy usually increase 30100%, with the highest values in the period between 10 to 20 days postoperatively 5. A rebound thrombocytosis may be seen with recovery after bone marrow injury with antineoplastic agents. May 29, 20 thrombocytosis is a blood disorder that is marked by headaches, chest pain and loss of consciousness and can even be lifethreatening for some sufferers. In addition, there are pappenheimer bodies upper left corner, howelljolly bodies centre left and prominent basophilic stippling centre. This report illustrates the diagnostic problems associated with a refractory post splenectomy thrombocytosis, and the therapeutic difficulties in the management ofprimary thrombocythaemiaarediscussed. Reactive secondary thrombocytosis williams manual of. If present, hypercoagulability could increase the risk for development of postsplenectomy thrombotic conditions such as portal syst. Thrombocytosis following splenectomy and aortic valve. We performed a retrospective study including 20 patients 416 years old who underwent splenectomy between 2006. Essential thrombocytosis 40 years after splenectomy bmj. Dec 01, 2020 the primary treatment of secondary thrombocytosis should address the underlying cause of the thrombocytosis. The case report and management emphasizes on post splenectomy thrombosis and its complications in itp patients.
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