Post splenectomy response in adult patients with immune thrombocytopenic purpura avinash supe 1, maulik parikh 1, ramkrishna prabhu 1, chetan kantharia 1, jijina farah 2 1 department of surgical gastroenterology, seth g s medical college and k e m hospital, parel, mumbai 400 012, india 2 department of haematology, seth g s medical college. However, although pcrsistcnt postsplenectomy thrombocytosis has thus been recognized for many years, the underlying cause is poorly understood and has scldom bccn discussed. Thrombocytosis increased platelet count, which can cause blood. A splenectomy is surgery to remove the entire spleen, a delicate, fistsized organ that sits under the left rib cage near the stomach. However, although pcrsistcnt post splenectomy thrombocytosis has thus been recognized for many years, the underlying cause is poorly understood and has scldom bccn discussed. The probability of thrombocytosis in patients who have had splenectomy is about 75. Hereditary spherocytosis, thrombocytosis, and chronic. Postsplenectomy reactive thrombocytosis request pdf. Thrombocythemia is a condition of high platelet thrombocyte count in the blood. A 20yearold male who required splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. Review of the literature revealed hs in association with pulmonary.
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. This report illustrates the diagnostic problems associated with a refractory post splenectomy thrombocytosis. 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 immunity and in protecting against infections. Similarly, in patients with extreme thrombocytosis, reactive thrombocytosis is a more common cause of thrombocytosis than primary or essential thrombocytosis. It causes a characteristic red or purple bruiselike rash and an increased tendency to bleed. Postsplenectomy reactive thrombocytosis europe pmc. The patients courses were marked by platelet abnormalities, both. Listing a study does not mean it has been evaluated by the u. Immune thrombocytopenia purpura itp, also known as idiopathic thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in.
Vascular complications after splenectomy for hematologic. During the past two years, postoperative thromboses of parts or all of the splanchnic venous circulation have developed in four of 30 patients with meyloproliferative disorders who have undergone splenectomy at our institution. The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. To our knowledge, this retrospective study of 318 patients without myeloproliferative disorders who underwent splenectomy is the largest of its type. Post splenectomy syndrome can occur after surgery to remove the spleen. Secondary thrombocytosis is more common than primary thrombocytosis. Postsplenectomy, platelet counts generally peak between postoperative day 7 and 20 and then return to normal within weeks or months. 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.
Splenectomy predisposes the individual to a lifelong increased risk of severe infections. Splenectomised and hyposplenic patients are at increased risk of lifethreatening infection due to encapsulated microorganisms such as streptococcus pneumoniae 90%, neisseria meningitidis, and. Postsplenectomy thrombocytosis could therefore be dismissed as. Splenectomy has been the conventional surgical treatment for patients with immune thrombocytopenic purpura itp. Thromboembolic complications after splenectomy 145. The effect of splenectomy on platelet formation and. Postsplenectomy thrombocytosis is a complication of splenectomy about which there is little published information. Thromboembolic risk of postsplenectomy thrombocytosis jama. Pdf postsplenectomy thrombocytosis with pseudohyperkalaemia. Acute myocardial infarction in a patient with post. Here you can read posts from all over the web from people who wrote about enlarged spleen and essential thrombocytosis, and check the relations between enlarged spleen and essential. In a series from a large us university hospital that included 280 patients with extreme thrombocytosis platelet. Immune thrombocytopenia purpura itp, also known as idiopathic thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in the absence of other causes of low platelets.
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. Mortality is significant and reported to be as high as 50% 4,5. Reactive thrombocytosis is generally a selflimiting condition that resolves with the inciting condition. 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. Postsplenectomy infection strategies for prevention in. Postsplenectomy thrombocytosis with pseudohyperkalaemia. There was a more gradual decrease in igm memory b cells reaching a stable level within 6 months after splenectomy. Besides a risk of localized or generalized infection there is also a well known risk of thromboembolic events due to. Postsplenectomy reactive thrombocytosis may occur in 7585% of patients, and splenectomy accounts for 19% of extreme thrombocytosis 19, 20.
Overwhelming postsplenectomy infection opsi is the most formidable infectious complication in the splenectomized patient. The platelet count in reactive thrombocytosis is expected to normalize after their solution of the underlying condition 2. As pointed out above, the combination of hyposplenism, b 12 replacement, and severe anemia could have precipitated extreme thrombocytosis in our patient. 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. Postsplenectomy syndrome can occur after surgery to remove the spleen. The case of long undiagnosed pseudohyperkalaemia in an 84yearold lady with thrombocytosis post splenectomy is. Reactive thrombocytosis is the presence of a high platelet count in response to infection, trauma, or surgery. It consists of a group of symptoms and signs such as. The primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis. In a series from a large us university hospital that included 280 patients with extreme thrombocytosis platelet count of 1,000 x 10 9 l or greater, 82% had secondary thrombocytosis. Apr 26, 2016 recently, hypercoagulation disorders have also been linked to splenectomy through loss of regulation of platelet activity, loss of filtering function and postsplenectomy thrombocytosis.
Until recently there have been no guidelines on how to diagnose and manage thrombocytosis. Managing uncontrolled postsplenectomy reactive thrombocytosis. The platelet count in reactive thrombocytosis is expected to normalize after. Among experimental and clinical measures which are reported to raise the platelet count, surgical procedures, particularly splenectomy, have attracted much attention. There is no evidence of an increased risk of thromboembolic disease but prophylactic aspirin may be considered for very high platelet counts. A 28 yearold smoking women who had previously undergone splenectomy due to hereditary spherocytosis with a moderate thrombocytosis platelet count 553635. Reactive thrombocytosis is the presence of high platelet count in response to infection, trauma, or surgery 4. Primary thrombocythaemia following splenectomy europe. Lifetime reactive thrombocytosis may also be present in patients who have had a splenectomy. Changes of asplenia in routine blood films including presence of howelljolly bodies hjb, occurred early median 25 days and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. Splenectomy, hyposplenism and asplenia information page patient. Overwhelming postsplenectomy infection opsi has a mortality rate of up to 50%. Giant right ventricular outflow tract thrombus in hereditary. Postsplenectomy response in adult patients with immune.
Splenectomy has been noted to be one of the main causes of reactive thrombocytosis. Acute myocardial infarction in a patient with postsplenectomy thrombocytosis. Oct 09, 2008 anticoagulation post laparoscopic splenectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Review of the literature revealed hs in association with pulmonary thrombosis, portal vein thrombosis, and cerebral infarction in two brothers, ttp in an asplenic patient and a patient with corpora cavernosum thrombosis causing segmental priapism. Thrombocytosis and thrombosis hematology american society. The patients courses were marked by platelet abnormalities, both quantitative and qualitative. Splenectomy alone accounts for 19% of all possible causes of extreme. Similarly, in patients with extreme thrombocytosis, reactive thrombocytosis is a more common cause of thrombocytosis than primary or. Postsplenectomy thrombocytosis is a known postoperative complication that has been reported by many authors. Patients with thalassemia and previous splenectomy appear to have an increased incidence of venous thromboembolism beyond the portal venous system. 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. One of the functions of the spleen is to help filter out impurities and worn out blood components, including red blood cells and platelets.
Normal count is in the range of 150,000 to 450,000 platelets per microlitre of blood. Thromboembolic complications after splenectomy for. For example, iron supplementation may normalize platelet counts in patients with thrombocytosis secondary to inflammatory bowel disease. The authors conclude that post splenectomy thrombocytosis is not associated with an increased risk for hemostatic complications 20. Splenectomy alone accounts for 19% of all possible causes of extreme thrombocytosis i. This article aims to outline diagnosis, investigation and management of patients with thrombocytosis and to highlight possible complications. Alesser degree ofthrombocytosis upto x1091 maypersist for longerperiods in patients whereanaemiacontinuesfollowing splenectomy. Changes of asplenia in routine blood films including presence of howelljolly bodies hjb, occurred early median 25 days and splenectomy associated thrombocytosis and. Recently, hypercoagulation disorders have also been linked to splenectomy through loss of regulation of platelet activity, loss of filtering function and postsplenectomy thrombocytosis.
Splenectomy associated changes in igm memory b cells in. Reactive thrombocytosis is a predictable finding after splenectomy, with the platelet count peaking at 1 to 3 weeks and. Recent studies have found that between 87% and 96% of people found to have platelet counts over 500, 000. Outline definition anatomy indications preoperative preparation. Postsplenectomy reactive thrombocytosis europe pmc article. This risk is independent of concurrent or recent use. Postoperative thrombocytosis jama internal medicine. Thromboembolic risk of postsplenectomy thrombocytosis. To define response to surgical therapy, pre operative factors influencing outcome. 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. 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. Unlike essential thrombocytosis, which is associated with thrombotic and hemorrhagic complications, reactive thrombocytosis rt is usually considered a benign process without thrombotic. Dec 24, 2018 secondary thrombocytosis is more common than primary thrombocytosis.
Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. Thrombocytosis may occur in 3 settings o reactive thrombocytosis in response to splenectomy, fe deficiency, acute hemorrhage, chronic inflammation, and malignancy. A specific issue is represented by the occurrence of thrombocytosis following splenectomy in pmf. Anatomic asplenia is most often due to surgical splenectomy, performed for trauma or therapeutically eg, for hemolytic anemias or immune thrombocytopenias. Here you can read posts from all over the web from people who wrote about enlarged spleen and essential thrombocytosis, and check the relations between enlarged spleen and essential thrombocytosis. The post splenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Postsplenectomy infection strategies for prevention in general practice background the spleen plays a crucial role in human defence against infection. Postoperative thrombocytosis has been found in 3% to % of patients who had splenectomy. It may develop immediately or as late as 65 years post splenectomy 24. Although thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. Patients who are asplenic or hyposplenic are at increased risk of severe sepsis due to specific organisms. Postsplenectomy thrombocytosis annals of internal medicine. Dec 24, 2018 the primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis. Splenectomy associated changes in igm memory b cells in an.
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