The role of thrombopoietin in post‐operative thrombocytosis

Abstract

Thrombopoietin (Tpo), the main regulator of thrombocytopoiesis, is a probable candidate to play a role in the increase in platelet counts that is frequently seen after surgery. In the current study, serial blood samples of patients that underwent major surgery were analysed with respect to Tpo kinetics, platelet turnover and inflammatory cytokines. Platelet Tpo content and plasma Tpo levels rose before platelet counts increased, suggesting that Tpo was indeed responsible for the elevation in platelet counts. In addition, an increase in interleukin 6 (IL‐6) levels, but not in IL‐11 and tumour necrosis factor alpha levels, was seen before the rise in Tpo concentration. In vitro, IL‐6 was shown to enhance Tpo production by the HepG2 liver cell line. Thus, increased Tpo levels after surgery, possibly resulting from enhanced Tpo production under the influence of IL‐6 or other inflammatory cytokines, are involved in an enhanced thrombocytopoiesis.

Platelet Dynamics in Peritoneal Carcinomatosis Patients Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Oxaliplatin

“…Since fewer TPO binding sites are available due to the low number of platelet counts induced by HIO, TPO increases and stimulates the proliferation of precursor cell, which ultimately will result in thrombocytosis (48). The magnitude of this feedback mechanism (0.621) is higher than the values reported in the literature for other anticancer agents (range 0.135 to 0.233) (49,52), probably because, after a major surgery, there is a further increase in circulating TPO due to its release from activated platelets (35).…”

“…The release of multiple inflammatory mediators after surgery stimulates megakaryocyte proliferation and differentiation which led to an increased platelet production (35,36). Therefore, CRS was assumed to increase k prol (Eq.…”

Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation: The role of the Warshaw procedure

“…They described that the postoperative platelet counts increased to maximum levels at 2 weeks after the operation in both patients who underwent an SVP and those who underwent a distal pancreatectomy with splenectomy. Although these early postoperative increases in the platelet count were induced by the inflammatory cytokines after the operations, the platelet counts at 3 months after the distal pancreatectomy with splenectomy were higher compared to those after SVP because of the loss of the spleen (26,27). Therefore, the late prolonged thrombocytosis might be related to the splenic function.…”

Postoperative Hematological Changes after Spleen-Preserving Distal Pancreatectomy with Preservation of the Splenic Artery and Vein

“…We also found that the postoperative platelet count peaked at 2 weeks after each type of surgery. This increase is referred to as reactive thrombocytosis, which is induced by inflammatory cytokines produced in response to surgical stress [31,32]. Reactive thrombocytosis is a common postoperative phenomenon and may be exacerbated by splenectomy [33].…”