Extreme Thrombocytosis in a Post Splenectomy Patient, a Rare Case Report

Abstract

Background

The normal platelet in healthremains from 1.5 L to 4.5 L/μL. Thrombocytosis can be defined as a platelet count 5 L/μL. Platelet counts >10 L/μLis very rare and it is known as extreme thrombocytosis.But usually happens to occur in myeloproliferative diseases or after spleen removal.Venousthrombosisin patient’s spleen removal have platelet counts in between 6L to 8 L/μL most of the time and its incidence is around 5%.platelet hyper aggregation is the ultimate outcome of these raised platelet count.Cause of thrombocytosis has no role in platelethyper aggregation; Hence, the choice of therapy is to prescribe platelet-antiaggregating medication such as aspirin. In a case of very platelet counts more than 10L/μL extreme thrombocytosis) along with associated   arterial or venous thrombosis, treatment option is to give cytoreductive agents such asanagrelide orhydroxyurea observingplatelet counts is mandatory.

Casereport

A 48-yeargentleman presented extreme thrombocytosis after splenectomy.In post-operativeperiod, reactive thrombocytosis was seen in this patient. Thrombocyte count   was increased to 1498 K/μL on postoperative day 8. Patient was investigated for common causes of thrombocytosis like myeloproliferative diseases and malignancies. To prevent thrombotic events low molecular weight heparin and aspirin was prescribed. The patient remained asymptomatic till discharge; Thrombocytosis gradually declined to 500 k/μL on post-operative day 15.

Discussion

The overall pathologicalsignificance of a raised thrombocyte count isusually neglected, it can be suggestive of presence of an associatedsepsis. Here it is our better try to find out relationship between raised platelet count and spleen removal. Another importance lies in a prevention of thromboembolic episodes.

Conclusions

Splenectomy was is a very common cause of thrombocytosis. the hyposplenism, could have precipitated extreme thrombocytosis in present case.