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