The primary treatment of secondary thrombocytosis reactive thrombocytosis should address the underlying cause of the thrombocytosis. Recent studies have found that between 87% and 96% of people found to have platelet counts over 500, 000. The same combination leads to an augmented leukocytotic response. First, the rise in the platelet count is more difficult to rationalize than.
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. No substantial increase in the incidence of thromboembolism was detected in patients with thrombocytosis. Results for post splenectomy prophylaxis 1 10 of 49 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a. Wbc and plt trends after splenectomy sages abstract archives. The white blood cell wbc and platelet plt counts typically increase after a splenectomy. Splenectomy, hyposplenism and asplenia information page patient.
Reactive thrombocytosis rt has been described following splenectomy. The authors conclude that post splenectomy thrombocytosis is not associated with an increased risk for hemostatic complications 20. The post splenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Postoperative thrombocytosis jama internal medicine jama. Five children during laparotomy were found to have an accessory spleen.
Accessory spleen in splenic trauma and reactive thrombocytosis. One of the functions of the spleen is to help filter out impurities and worn out blood components, including red blood cells and platelets. Reactive thrombocytosis is the presence of high platelet count in response to infection, trauma, or surgery 4. Splenectomy predisposes the individual to a lifelong increased risk of severe infections. How is thrombocytosis managed following splenectomy for. 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. This phenomenon is of interest for at least two reasons. There is no evidence of an increased risk of thromboembolic disease but prophylactic aspirin may be considered for very high platelet counts. The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Thrombocytosis is a physiologic response to splenectomy. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and. 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.
Virtually all individuals undergoing splenectomy experience a thrombocytosis acutely. We report a case of prolonged extreme reactive thrombocytosis in a post splenectomy patient with heredi tary spherocytosis. It is most common in patients with massive splenomegaly from myeloproliferative disorders. Postsplenectomy response in adult patients with immune thrombocytopenic purpura avinash supe 1, maulik parikh 1, ramkrishna prabhu 1, chetan kantharia 1, jijina farah 2 1 department of surgical gastroenterology, seth g s medical college and k e m hospital, parel, mumbai 400 012, india 2 department of haematology, seth g s medical college. Furthermore various thresholds for clinical intervention based on wbc and plt has been introduced, but there is little evidence to support these criteria. Nonelective splenectomy patients should be vaccinated at least 14 days postsplenectomy or at time of discharge from the hospital. Postsplenectomy syndrome definition of postsplenectomy. Reactive thrombocytosis is the presence of a high platelet count in response to infection, trauma, or surgery. Among experimental and clinical measures which are reported to raise the platelet count, surgical procedures, particularly splenectomy, have attracted much attention. A splenectomy is surgery to remove the entire spleen, a delicate, fistsized organ that sits under the left rib cage near the stomach. Vol 378 july 2, 2011 post splenectomy 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.
Besides a risk of localized or generalized infection there is also a well known risk of thromboembolic events due to thrombocytosis postsplenectomy. 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. Predictive factors for platelet count variation after splenectomy in. 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. Vol 378 july 2, 2011 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. It is the spleens job to store these platelets, so when its gone there is no place to store them anymore, so more are present in the bloodstream. Post splenectomy response in adult patients with immune thrombocytopenic purpura avinash supe 1, maulik parikh 1, ramkrishna prabhu 1, chetan kantharia 1, jijina farah 2 1 department of surgical gastroenterology, seth g s medical college and k e m hospital, parel, mumbai 400 012, india 2 department of haematology, seth g s medical college. Oct 09, 2008 splenicportal vein thrombosis is an alarming complication of splenectomy.
Postsplenectomy syndrome uf health, university of florida. Thromboembolic complications after splenectomy for. When its removed wbcs increase till the liver can take over this function. Retrospective studies in the literature have shown the incidence of symptomatic splenicportal vein thrombosis to be between 0. Reactive thrombocytosis is generally a selflimiting condition that resolves with the inciting condition. Lifetime reactive thrombocytosis may also be present in patients who have had a splenectomy. However, previous thrombocyte levels as documented during the sah and during routine. Secondary thrombocytosis is more common than primary thrombocytosis. More specifically, in post splenectomy patients there is a risk of pulmonary complications such as.
Alesser degree ofthrombocytosis upto x1091 maypersist for longerperiods in patients whereanaemiacontinuesfollowing splenectomy hirsh and dacie, 1966. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. Postsplenectomy syndrome multimedia encyclopedia health. Thromboembolic complications after splenectomy 145. Prolonged extreme thrombocytosis in a postsplenectomy patient. Reactive thrombocytosis is a predictable finding after splenectomy, with the platelet count peaking at 1 to 3 weeks and. An overwhelming post splenectomy infection opsi is a rare but rapidly fatal infection occurring in individuals following removal or permanent dysfunction of the spleen. Adults with underlying immunosuppression, particularly those with malignancy, should be given antibiotic prophylaxis. An overwhelming postsplenectomy infection opsi is a rare but rapidly fatal infection occurring in individuals following removal or permanent dysfunction of the spleen. We appreciate your patience, support and loyalty as our healthcare team members have worked tirelessly at the forefront of response to the covid19 pandemic in our community.
It consists of a group of symptoms and signs such as. Anticoagulation post laparoscopic splenectomy full text. Asplenic patients should be revaccinated at the appropriate time interval for each vaccine. Thromboembolic risk of postsplenectomy thrombocytosis. The platelet count in reactive thrombocytosis is expected to normalize after resolution of the underlying condition. The spleen is an important part of the bodys defense immune. Level 3 elective splenectomy patients should be vaccinated at least 14 days prior to the operation. Postsplenectomy reactive thrombocytosis request pdf.
Similarly, in patients with extreme thrombocytosis, reactive thrombocytosis is a more common cause of thrombocytosis than primary or essential thrombocytosis. Besides a risk of localized or generalized infection there is also a well known risk of thromboembolic events due to thrombocytosis post splenectomy. Managing uncontrolled postsplenectomy reactive thrombocytosis. Discussion with an infectious diseases physician will allow individualisation of the treatment regimen.
There was a more gradual decrease in igm memory b cells reaching a stable level within 6 months after splenectomy. Postsplenectomy syndrome can occur after surgery to remove the spleen. Basics topic beyond the basics topic patients with impaired splenic function are at risk for severe and overwhelming infection with encapsulated. Postsplenectomy reactive thrombocytosis has an incidence of about 75% to 82%. Essential thrombocytosis 40 years after splenectomy bmj case.
The frequency of chronic inflammation was higher in the severe thrombocytosis group compared to. A lthough thrombocytosis is a very common finding after splenectomy, the thromboembolic risk of postsplenectomy thrombocytosis has not been clarified. Thrombosis in association with elevated platelet count after splenectomy is well recognized, with an incidence of. Postsplenectomy thrombocytosis is a complication of splenectomy about which there is little published information. Nonelective splenectomy patients should be vaccinated at least 14 days post splenectomy or at time of discharge from the hospital. The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. The spleen plays a major role in platelet regulation, as it is the primary site of destruction of platelets, which is why thrombocytosis is seen with hyposplenism 7,8. Splenectomy was the first effective therapy for hcl and remained the initial treatment of choice until approximately 2 decades ago. Well, as you already know, thrombocytosis is an abnormally high platelet count present within the bloodstream. Postsplenectomy reactive thrombocytosis europe pmc article. Thrombocytosis increased platelet count, which can cause blood. Leukocytosis after splenectomy answers on healthtap. In another study of 280 patients with a platelet count 1,000.
Jun 06, 2011 well, as you already know, thrombocytosis is an abnormally high platelet count present within the bloodstream. Postsplenectomy thrombocytosis could therefore be dismissed as. More specifically, in postsplenectomy patients there is a risk of pulmonary complications such as. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications.
Intraoperatively, an accessory spleen was identified in the left splenorenal space which remained intact and was salvaged during the operation. Pdf blood changes after splenectomy in portal hypertension. The infections are typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including streptococcus pneumoniae. There are two main approaches to using antibiotics to prevent severe infections in asplenic and hyposplenic interest. Discussion with an infectious diseases physician will. Changes of asplenia in routine blood films including presence of howelljolly bodies hjb, occurred early median 25 days and splenectomy associated thrombocytosis and lymphocytosis peaked by 50 days. Splenicportal vein thrombosis is an alarming complication of splenectomy. A subcapsular hematoma or pseudoaneurysm may rupture some time after blunt trauma that classically occurs about 2 weeks after the initial injury and presents with shock abdominal pain.
Splenectomy associated changes in igm memory b cells in an. Since the incidence of postsplenectomy reactive thrombocytosis is cited at 75 82% and the incidence of thrombosis associated with it is. Thrombocytosis in the face of splenectomy rarely requires treatment. To our knowledge, this retrospective study of 318 patients without myeloproliferative disorders who underwent splenectomy is the largest of its type. Results rt platelets500x109 occurred after the 7th postsplenectomy day in both. In cases of reactive thrombocytosis of more than 1,000x10 9 l, it may be considered to administer daily low dose aspirin such as 65 mg to minimize the risk of stroke or thrombosis. 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. Here you can read posts from all over the web from people who wrote about enlarged spleen and essential thrombocytosis, and check the relations between enlarged spleen and.
Thrombosis in association with elevated platelet count after splenectomy is well. Many complications postsplenectomy may be expected. Splenectomy alone accounts for 19% of all possible causes of extreme thrombocytosis i. Reactive thrombocytosis is a predictable finding after splenectomy, with the. Post splenectomy syndrome can occur after surgery to remove the spleen. Here you can read posts from all over the web from people who wrote about enlarged spleen and essential thrombocytosis, and check the relations between enlarged spleen and essential thrombocytosis. Splenectomy associated changes in igm memory b cells in. Of 484 patients included, 63% had thrombocytosis due to an infectious disease, 11. Postsplenectomy thrombocytosis is a known postoperative complication that has been reported by many authors. We present the case of a 25yearold male patient who underwent a splenectomy due to injury of the spleen accompanied by haemodynamic instability.
These changes make interpretation of postoperative lab values difficult and may unduly raise concerns for complications. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Dec 24, 2018 secondary thrombocytosis is more common than primary thrombocytosis. Hematology a constellation of findings that follow splenectomy, which are most marked in the erythroid series, as the spleen is responsible for pitting and culling effete or defective rbcs clinical thrombocytosis, hemolysis, risk of severe infections, especially to encapsulated bacteriaeg, s pneumonia lab. As pointed out above, the combination of hyposplenism, b 12 replacement, and severe anemia could have precipitated extreme thrombocytosis in our patient. Excellence in clinical quality, safety and patient experience are hallmarks of the healthcare at st. Postsplenectomy response in adult patients with immune. For example, iron supplementation may normalize platelet counts in patients with thrombocytosis secondary to inflammatory bowel disease. Postoperative thrombocytosis jama internal medicine. In this study, splenectomized patients had higher wbc counts than those of nonsplenectomized.
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