Critical Care Medicine-Hematologic and Oncologic Disorders>>>>>Platelet Disorders
Question 5#

A 29-year-old male is admitted to the intensive care unit after undergoing an uncomplicated laparoscopic splenectomy for idiopathic thrombocytopenic purpura. On post-op day 2, he is recovering well, is afebrile, is hemodynamically stable, and has no complaints. Routine laboratory test results are sent, which are significant for a platelet count of 654,000/µL.

What is the most likely cause of thrombocytosis in this patient? 

A. Sepsis
B. Reactive thrombocytosis
C. Cancer
D. Lab error

Correct Answer is B

Comment:

Correct Answer: B

Thrombocytosis is defined as platelet levels more than 450,000/µL and can be seen in sepsis, hematologic malignancy, or postsplenectomy. This patient most likely has a postsplenectomy-reactive thrombocytosis. As the spleen is a major site for platelet regulation and removal, thrombocytosis is seen in the acute postsplenectomy period and normalizes over time, typically reaching normal levels within 1 month.

Complications arising from the thrombocytosis have been reported and are most commonly thrombotic events in the mesenteric and hepatic vasculature, although rare cerebral and cardiac occlusions have been reported. Treatment of thrombocytosis is dependent on the presentation and patient’s risk factors. Antiplatelet agents such as hydroxyurea and anagrelide have been used with positive results, although side effects such as leukemic transformation and anemia have been reported respectively. In a situation where thrombocytosis is posing a threat to life, plasmapheresis can be utilized for rapid reduction.

References:

  1. Supe A, Parikh M, Prabhu R, Kantharia C, Farah J. Post-splenectomy response in adult patients with immune thrombocytopenic purpura. Asian J Transfus Sci. 2009;3(1):6-9. doi:10.4103/0973-6247.45255.
  2. Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Post-splenectomy reactive thrombocytosis. Proc (Bayl Univ Med Cent). 2009;22(1):9-12.