Impact of splenectomy on postsurgical platelet count american. Thrombosis in association with elevated platelet count after splenectomy is well. Splenectomy vaccine protocol for pediatric solid organ. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. By 1 to 5 years postsplenectomy, 95% of patients in our analysis had platelet. Ellman l 1978 thromboembolic risk of postsplenectomy thrombocytosis.
Postsplenectomy thrombocytosis is a known postoperative complication that has been reported by many authors. Spleen splenomegaly spleen radiology splenic biopsy diagnostic splenectomy summary splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Description thrombocytosis is an abnormally increased number of platelets in the blood. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries. The medical files of patients who underwent splenectomy between january. Information for patients postsplenectomy or with functional. Secondary thrombocytosis is more common than primary thrombocytosis. Advise pregnant women of the potential risk to a fetus. Preoperative embolization of the splenic artery in patients. The spleen is found in the upper left quadrant of the abdomen and. Postsplenectomy reactive thrombocytosis may occur in 7585% of patients, and splenectomy accounts for 19% of extreme thrombocytosis 19, 20. The patients courses were marked by platelet abnormalities, both quantitative and qualitative.
In routine clinical practice, thrombocytosis is much more likely to be reactive 80% of cases than primary. Give 1st dose 7 14 days prior to elective splenectomy or at least 7 days after emergency splenectomy. Blunt abdominal trauma, splenectomy, and postsplenectomy vaccination cpg id. Vegetables that contain salicylates include cucumber, mushrooms, zucchini, radish, and alfalfa. However, you can take steps to reduce your risk for complications. Reactive thrombocytosis is usually associated with infections, inflammation, trauma, hemolysis, metastatic cancer, the postsplenectomy state, or iron deficiency. 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. Studies have shown that most people who have platelet counts over 500,000 have secondary thrombocytosis. Advise females of reproductive potential to use effective contraception during treatment and for at least 3 months after the final. Thrombocytosis management and treatment cleveland clinic. A 20yearold male who required splenectomy following abdominal trauma was subsequently shown to have primary thrombocythaemia. Medical complications following splenectomy sciencedirect. Anatomic asplenia is most often due to surgical splenectomy, performed for trauma or therapeutically eg, for hemolytic anemias or immune thrombocytopenias.
It is most common in patients with massive splenomegaly from myeloproliferative disorders. The incidence of thrombosis after splenectomy is approximately 5% and accounts for about 19% of cases in hospitalized patients. 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. In this procedure, a special instrument is used to remove blood from the patient, separate and remove the platelets, and then return the other blood cells to the patient. Myelofibrosis is also known by several other names, including agnogenic myeloid metaplasia, chronic idiopathic myelofibrosis, myelosclerosis with.
Specific management required for postsplenectomy patients see below in victoria, australia, patients can be placed on a splenectomy registry to help ensure appropriate followup. As pointed out above, the combination of hyposplenism, b 12 replacement, and severe anemia could have precipitated extreme thrombocytosis in our patient. The miscellaneous group consisted of patients with thrombocytosis following upper gastrointestinal bleeding in five cases, iron deficiency anaemia of unknown origin in two cases and autoimmune haemolytic anaemia in one case. This report illustrates the diagnostic problems associated with a refractory postsplenectomy thrombocytosis, and the therapeutic difficulties in the management of primary thrombocythaemia are discussed. Thrombocytopenia often occurs as a result of a separate disorder, such as leukemia or an immune system problem. Screening and prevention thrombocythemia and thrombocytosis. Thrombocytosis is a condition that may have many causes. Postsplenectomy syndrome can occur after surgery to remove the spleen. Platelets thrombocytes are colorless blood cells that help blood clot. In another study of 280 patients with a platelet count 1,000. Dec 24, 2018 the primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis.
Postsplenectomy thrombocytosis annals of internal medicine. What links here related changes upload file special pages permanent link page information. Hereditary spherocytosis, thrombocytosis, and chronic. Although the indications for splenectomy have decreased in current trauma management and cancer surgery, splenectomy remains a frequently performed surgical procedure. Chronic inflammatory disorders eg, rheumatoid arthritis, inflammatory bowel disease, tuberculosis, sarcoidosis, granulomatosis. It consists of a group of symptoms and signs such as. Oct 02, 2018 surgical splenectomy risk factor for vte in. In a study of 129 patients with extreme thrombocytosis 1,000 gl, 72 in mpd and 57 with reactive thrombocytosis, thrombosis was found in 34% 18, but a prospective observational study of patients with essential thrombocythemia et and a platelet count thrombocytosis is the presence of high platelet count in response to infection, trauma, or surgery 4. Between 10 and 15 percent of mf cases begin as either polycythemia vera or essential thrombocythemia.
Thrombocytosis definition thrombocytosis is a blood disorder in which the body produces a surplus of platelets thrombocytes. Since the incidence of postsplenectomy reactive thrombocytosis is cited at 7582% and the incidence of thrombosis associated with it is approximately 5%, depending on other associated risk. Mild thrombocytosis may be observed after a splenectomy due to the lack of. Splenectomy for the treatment of thrombotic thrombocytopenic. For example, iron supplementation may normalize platelet counts in patients with thrombocytosis secondary to inflammatory bowel disease. 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. Immunisation boosted every 5 years meningococcal c. Before splenectomy, there was a positive correlation between platelet density and. Although thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. Prolonged extreme thrombocytosis in a postsplenectomy patient. In general, no treatment is indicated to directly reduce the platelet count. Secondary thrombocytosis is more common than primary thrombocythemia.
Its association with mesenteric, portal, andor renal vein thrombosis in patients with myeloproliferative disorders. The effect of splenectomy on platelet formation and megakaryocyte. Thromboembolic complications after splenectomy for. Reactive thrombocytosis is the presence of high platelet count in response to infection, trauma, or surgery 4. 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.
In the relapsing cases in group b, the relapse rate in our series decreased from 074patientyear before splenectomy to 010patientyear after splenectomy, equalling a calculated postsplenectomy relapse rate of 010patientyear as reported in 45 patients in the literature since 1980. Thrombocytosis definition of thrombocytosis by medical. Essential thrombocytosis 40 years after splenectomy bmj. Approach to the patient with thrombocytosis uptodate. What type of care is required for the postsplenectomy patient. This file may not be suitable for users of assistive technology. Despite such encouraging results, the separate analysis.
It may develop immediately or as late as 65 years post splenectomy 24. There is no evidence of an increased risk of thromboembolic disease but prophylactic aspirin may be considered for very high platelet counts. 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. Splenectomy alone accounts for 19% of all possible causes of extreme thrombocytosis i. Similarly, in patients with extreme thrombocytosis, reactive thrombocytosis is a more common cause of thrombocytosis than primary or essential thrombocytosis. Prolonged extreme thrombocytosis in a postsplenectomy. Overwhelming post splenectomy infection how is overwhelming post splenectomy infection abbreviated. Both the platelet count at 1 week and 1 month after the operation p splenectomy or post mortem examination, and it is surprisingly dif. A splenectomy is surgery to remove the entire spleen, a delicate, fistsized organ that sits under the left rib cage near the stomach.
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. Secondary thrombocytosis is primarily cytokine mediated and includes etiologies such as infection, connective tissue diseases, postsurgical, post. Vaccinations and antibiotic treatment post splenectomy medscape. The effect of splenectomy on platelet formation and megakaryocyte dna content in. Thrombocytosis is defined as 500,000 plateletsmm 3 and usually is a secondary or reactive event related to underlying conditions. The spleen is an important part of the bodys defense immune. The primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis. Reactive thrombocytosis is the presence of a high platelet count in response to infection, trauma, or surgery.
Thrombocytopenia low platelet count symptoms and causes. Postsplenectomy thrombocytosis and managements juniper. 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. Feb 12, 2015 if pre splenectomy vaccines are not possible then the vaccines should be given 2 weeks postop except when there is immunosuppression then vaccines should be delayed until 3 months post op which is typically when the period of intense immunosuppression is over. Spleen australia vaccines recommended for adults 18 years. Postsplenectomy reactive thrombocytosis request pdf.
The post splenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Aetiology and clinical significance of thrombocytosis. Listing a study does not mean it has been evaluated by the u. The infections are typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including streptococcus pneumoniae. How i work up the patient with thrombocytosis the asco post. Clinical manifestations and diagnosis of specific causes of thrombocytosis are discussed separately. Overwhelming postsplenectomy infection how is overwhelming. Anticoagulation post laparoscopic splenectomy the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This topic discusses our approach to the adult or child with unexplained thrombocytosis. The authors conclude that postsplenectomy thrombocytosis is not associated with an increased risk for hemostatic complications 20.
Jan 03, 20 thrombocytopenia, defined as a platelet count 26 000 women suggest that its prevalence at the end of pregnancy is between 6. The same combination leads to an augmented leukocytotic response. To promote a fact sheet and patient advice card to help with care of patients pre and post splenectomy or if a patient is diagnosed with functional hyposplenism secondary to diseases such as rheumatoid arthritis or amyloidosis. The platelet count in reactive thrombocytosis is expected to normalize after resolution of the underlying condition.
Thromboembolic risk of postsplenectomy thrombocytosis. Mortality is significant and reported to be as high as 50% 4,5. 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. Thrombocytosis is a physiologic response to splenectomy. A splenectomy is the surgical procedure that partially or completely removes the spleen. Conclusion in normal patients post splenectomy reactive thrombocytosis does not need any treatment inspite of high thrombocyte count in 70 to 80 percent of case. They also boost the bodys immunity and help to maintain normal platelet count. Functional asplenia refers to complete loss of function caused by medical conditions and occurs most frequently with sickle cell anemia 2.
Aug 26, 2019 eat fruit and veg containing salicylates which help to thin the blood. To our knowledge, this retrospective study of 318 patients without myeloproliferative disorders who underwent splenectomy is the largest of its type. Plateletbound vwf in prp adjusted to a platelet count of 200. Secondary thrombocytosis subsides when the underlying process causing the elevated platelet count resolves treatment of infection, recovery from surgery, etc. Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%.
Dec 24, 2018 secondary thrombocytosis is more common than primary thrombocytosis. Anticoagulation post laparoscopic splenectomy full text. Thrombocytosis in the face of splenectomy rarely requires treatment. Although reactive thrombocytosis is a predictable finding after splenectomy, with the platelet count peaking at weeks and returning to normal levels in weeks, months, and, rarely, years we planned thrombocytapheresis in our patient because of the rapidity and significant rise of the platelet count in the 24 h after splenectomy. Our results support the wellknown phenomenon of postsplenectomy thrombocytosis and illustrate the. Platelets are blood cells that stick together, helping blood to clot. Postsplenectomy thrombocytosis is a complication of splenectomy about which there is little published information. Managing uncontrolled postsplenectomy reactive thrombocytosis. How is thrombocytosis managed following splenectomy for. Fruit and vegetables that contain salicylates help to thin the blood and prevent clotting. How i treat thrombocytopenia in pregnancy blood american. A 69yearold man presented at our department of neurology in december 2016 with acute aphasia. Overwhelming post splenectomy infection listed as opsi.
Secondary thrombocytosis is primarily cytokine mediated and includes etiologies such as infection, connective tissue diseases, postsurgical, post splenectomy, acute blood loss, irondeficiency. Abstract complications of postsplenectomy, especially. Virtually all individuals undergoing splenectomy experience a thrombocytosis acutely. This risk is independent of concurrent or recent use. Reactive thrombocytosis is an elevated platelet count 450,000mcl that develops secondary to another disorder. Care after the removal of the spleen splenectomy or if your spleen doesnt work properly functional hyposplenism fact sheets currently selected your spleen is important for your bodys defence against germs, when your spleen is removed or doesnt work properly you are at higher risk of infection. Registration form fax03 9076 2431 or register online au v 22415 spleen australia based at the alfred hospital. Thrombocythemia and thrombocytosis national heart, lung. Influence of splenectomy on platelet morphometry and function. Thrombocytosis increased platelet count, which can cause blood. In cases of severe lifethreatening thrombocytosis, a procedure called plateletpheresis is performed to immediately lower the platelet count to safer levels.
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