Postsplenectomy Reactive Thrombocytosis

Abstract

Thrombocytosis is frequently encountered as an incidental laboratory finding. The most common etiology is reactive (secondary) thrombocytosis due to infections, trauma, surgery, or occult malignancy. Even though thrombocytosis is benign and self-limiting in most cases, it can result in hemorrhage or thrombosis. The hypercoagulable state is characterized by episodes of thrombosis and can be due to inherited or acquired conditions. Extreme thrombocytosis may result in thrombotic events such as acute myocardial infarction, mesenteric vein thrombosis, and pulmonary embolism. It is important for physicians to be familiar with the complications associated with thrombocytosis. Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%. Thrombosis in association with elevated platelet count after splenectomy is well recognized, with an incidence of approximately 5%. This case report describes a 61-year-old patient who underwent emergent splenectomy and presented 1 week later with acute ST segment elevation myocardial infarction. Severe thrombocytosis, which was not present prior to splenectomy, was noted, and a diagnosis of reactive thrombocytosis was initially made. Involvement of the right coronary artery led to emergent percutaneous transluminal coronary angioplasty. Essential thrombocytosis was considered when treatment with hydroxyurea failed to lower the platelet count. A review of arterial and venous thrombosis in patients with severe thrombocytosis is presented, and the approach to the management of such patients is discussed.

Risk factors detection in chronic thromboembolic pulmonary hypertension, a tool for risk quantification?

“…The other explanation of increased risk for CTEPH following a splenectomy could be the reactive thrombocytosis. After having the splenectomy, an increase in circulating microparticles and negatively charged phospholipids is enhanced by experimental thrombus induction (18,19,20). One of the consequences of having a splenectomy and presumably also the cause of infection and cancer may lie in increased plasma levels of microparticles and anionic phospholipids, and may explain the abnormal tendency to thrombosis in CTEPH (20).…”

The Effects of Splenectomy and Autologous Spleen Transplantation on Complete Blood Count and Cell Morphology in a Porcine Model

“…However, total removal of the spleen may lead to side effects such as postsplenectomy infections and sepsis, due to the decreased production of antibodies and phagocytes or thrombosis, due to elevated platelet count in blood (Bessler et al, 2004;Khan et al, 2009;Miko et al, 2003;Timens & Leemans, 1992). Also, many studies report increased count of morphologically abnormal erythrocytes, immature red blood cells and pathologic erythrocyte inclusions in the peripheral blood of various species following splenectomy as a result of the loss of splenic filtrating function (Haklar et al, 1997;Resende et al, 2002;Traub et al, 1987).…”

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“…27 Transient thrombocytosis has been described after splenectomy; however, the peak platelet count appears to occur between the seventh and twentieth days after the operation. 28 Studies that have compared laboratory tests of renal transplant patients with those of healthy individuals have shown lymphopenia without alterations in the total leukocyte counts. 29 The autogenic implants were viable and exhibited phagocytic activities 3 months after the operations.…”