Essential thrombocytosis 40 years after splenectomy. In general, no treatment is indicated to directly reduce the platelet count. A specific issue is represented by the occurrence of thrombocytosis following splenectomy in pmf. All the information, content and live chat provided on the site is intended to be for informational purposes only, and not. Reactive thrombocytosis is the presence of high platelet count in response to infection, trauma, or surgery 4. Postsplenectomy thrombocytosis is a complication of splenectomy about which there is little published information. This topic discusses our approach to the adult or child with unexplained thrombocytosis. Thromboembolic complications after splenectomy 145.
Specific details have been explored in question 18 from the second paper of 2007. This phenomenon is of interest for at least two reasons. The spleen plays a central role in a range of diseases. Vascular complications after splenectomy for hematologic.
Pdf postsplenectomy thrombocytosis with pseudohyperkalaemia. 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. Blood coagulation and platelet profiles in persistent postsplenectomy thrombocytosis. Although thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. The primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis.
In routine clinical practice, thrombocytosis is much more likely to be reactive 80% of cases than primary. Reactive thrombocytosis is usually associated with infections, inflammation, trauma, hemolysis, metastatic cancer, the postsplenectomy state, or iron deficiency. Postsplenectomy thrombocytosis could therefore be dismissed as. How is thrombocytosis managed following splenectomy for. Vascular complications after splenectomy for hematologic disorders. Splenectomy and postsplenectomy complications are a common topic in the saqs.
It is most common in patients with massive splenomegaly from myeloproliferative disorders. Influence of splenectomy on platelet morphometry and function. Among experimental and clinical measures which are reported to raise the platelet count, surgical procedures, particularly splenectomy, have attracted much attention. Postsplenectomy thrombocytosis and managements juniper.
A coiisidcration of thc nicchanisni of postsplenectomy thrombocytosis and its possible bearing on postsplenectomy thromboembolism forms the basis of this report. Thrombosis in association with elevated platelet count after splenectomy is well recognized, with an incidence of approximately 5%. Thromboembolic risk of postsplenectomy thrombocytosis jama. For example, iron supplementation may normalize platelet counts in patients with thrombocytosis secondary to inflammatory bowel disease. 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. Thromboembolic complications after splenectomy for. This report illustrates the diagnostic problems associated with a refractory postsplenectomy thrombocytosis, and the therapeutic difficulties in the management of primary thrombocythaemia are discussed. Its association with mesenteric, portal, andor renal vein thrombosis in patients with myeloproliferative disorders. Management of the postsplenectomy patient deranged.
Postsplenectomy reactive thrombocytosis request pdf. However, recognition and clinical management of opsi is not well established. Before splenectomy, there was a positive correlation between platelet density and. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. Postsplenectomy thrombocytosis with pseudohyperkalaemia. Download here free healthcaremagic app to ask a doctor. 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. A 20yearold male who required splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. Other causes of thrombocytosis, such as reactive thrombocytosis or inflammatory diseases or autoimmune or paraneoplastic thrombocytosis, have. How i work up the patient with thrombocytosis the asco post. However, although pcrsistcnt postsplenectomy thrombocytosis has thus been recognized for many years, the underlying cause is poorly understood and has scldom bccn discussed. 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. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and. Postsplenectomy reactive thrombocytosis may occur in 7585% of patients, and splenectomy accounts for 19% of extreme thrombocytosis 19, 20.
Postoperative thrombocytosis jama internal medicine. Given the immediate risk of the thrombotic complications, the aim of this study was to evaluate clinical and laboratory patient characteristics in nontraumatic diseases of the spleen, and to. It is important for physicians to be familiar with the complications associated with 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. The same combination leads to an augmented leukocytotic response. Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%. Anticoagulation post laparoscopic splenectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The authors conclude that post splenectomy thrombocytosis is not associated with an increased risk for hemostatic complications 20.
Clinical manifestations and diagnosis of specific causes of thrombocytosis are discussed separately. First, the rise in the platelet count is more difficult to rationalize than. It consists of a group of symptoms and signs such as. The case of long undiagnosed pseudohyperkalaemia in an 84yearold lady with thrombocytosis post splenectomy is. Overwhelming postsplenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. One of the functions of the spleen is to help filter out impurities and worn out blood components, including red blood cells and platelets. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. The platelet count in reactive thrombocytosis is expected to normalize after resolution of the underlying condition. Thrombosis in association with elevated platelet count after splenectomy is well.
Postsplenectomy syndrome can occur after surgery to remove the spleen. Carcinogenesis, prevention and cancer therapeutics pdf free book essential oils natural remedies. Thrombocytosis increased platelet count, which can cause blood. Postsplenectomy thrombocytosis is a known postoperative complication that has been reported by many authors. Virtually all individuals undergoing splenectomy experience a thrombocytosis acutely. A lifethreatening hypercoagulable state hcs is reported that developed after splenectomy in idiopathic thrombocytopenic purpura itp. As such, great emphasis has been placed on the procedure of spleen removal, the benefits and the numerous associated complications.
This risk is independent of concurrent or recent use. Here, we report a case of postsplenectomy secondary thrombocytosis presenting with extremely high platelet counts and subsequent. Blood coagulation disorders pdf haemostasis essential manual of 24 hour blood pressure management pdf essential facts on the go internal medicine pdf essential and nonessential metals. A 50yearold active male was rejected for blood donation because of an incidental finding of low platelet counts, 40,000ul. 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. Listing a study does not mean it has been evaluated by the u.
Secondary thrombocytosis is more common than primary thrombocytosis. The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms. The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Ellman l 1978 thromboembolic risk of postsplenectomy thrombocytosis. In another study of 280 patients with a platelet count 1,000. Thrombocytosis in the face of splenectomy rarely requires treatment.
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