| Peer-Reviewed

Extreme Reactive Thrombocytosis Post-Splenectomy in 16 Years Old Boy

Received: 20 May 2021    Accepted: 7 June 2021    Published: 16 June 2021
Views:       Downloads:
Abstract

Thrombocytosis is a common occurrence in childhood. The most common causes of thrombocytosis are infection, trauma, surgery, and malignancy. Splenectomy may cause reactive thrombocytosis, which affects approximately 75-80% of patients and is associated with an increased risk of thrombotic and hemorrhagic complications. The appearance of thrombocytosis must be diagnosed in order to determine the treatment and prognosis. Antiplatelet agents, cytoreductive therapy, and/or therapeutic apheresis can be used to accomplish this. We reported a 16-year-old male who developed extreme reactive thrombocytosis following splenectomy. He was admitted to the hospital with a grade IV spleen rupture as a result of blunt abdominal trauma and underwent total splenectomy. After splenectomy, his platelet count was 229x109/L and increased to 1154x109/L on the ninth postoperative day. He stated that he was suffering from a fever, headache, fatigue, and abdominal pain. Therefore, he was referred to a consultant pediatric haemato-oncology specialist for thrombocytosis management and was diagnosed with extreme reactive thrombocytosis. Cytoreductive agents such as hydroxyurea were used to treat him. His platelet count decreased to less than 400x109/L after 37 days of treatment. At 1-year follow-up, his complete blood count remains normal. He has been asymptomatic. We concluded that splenectomy may lead to extreme thrombocytosis, resulting in thrombotic and hemorrhagic complications. Thus, physicians should clinically monitor patients to ensure prompt diagnosis and appropriate treatment, as well as to prevent thrombosis and hemorrhage complications.

Published in American Journal of Pediatrics (Volume 7, Issue 3)
DOI 10.11648/j.ajp.20210703.11
Page(s) 95-99
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Extreme Thrombocytosis, Post-splenectomy, Cytoreductive, Hydroxyurea

References
[1] Ayse B, Seda O. Evaluation of intra-abdominal solid organ injuries in children. Acta Bio Medica: Atenei Parmensis. 2018; 89 (4): 505.
[2] Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, Adelgais K, Ellison AM, Yen K, Atabaki S, Menaker J. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013; 62: 107-16.
[3] Drucker NA, McDuffie L, Groh E, Hackworth J, Bell TM, Markel TA. Physical examination is the best predictor of the need for abdominal surgery in children following motor vehicle collision. J Emerg Med. 2018; 54 (1): 1-7.
[4] Simpson RA, Ajuwon R. Occult splenic injury: delayed presentation manifesting as jaundice. Emerg Med J. 2001; 18: 504.
[5] Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs Jr TJ, Sangosanya A, Schuster KM. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012; 73: S294-300.
[6] Buzelé R, Barbier L, Sauvanet A, Fantin B. Medical complications following splenectomy. J Visc Surg. 2016; 153 (4): 277-86.
[7] Khan PN, Nair RJ, Olivares J, Tingle LE, Li Z. Postsplenectomy reactive thrombocytosis. Proc (Bayl Univ Med Cent). 2009; 22 (1): 9–12.
[8] Lin JN, Chen HJ, Lin MC, Lai CH, Lin HH, Yang CH, Kao CH. Risk of venous thromboembolism in patients with splenic injury and splenectomy. Thromb Haemost. 2016; 115 (01): 176-83.
[9] Zvizdic Z, Kovacevic A, Milisic E, Jonuzi A, Vranic S. Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country. PloS one. 2020; 15 (8): e0237016.
[10] Subramaniam N, Mundkur S, Kini P, Bhaskaranand N, Aroor S. Clinicohematological study of thrombocytosis in children. Int Sch Res Not. 2014; 1-4.
[11] Bleeker JS, Hogan WJ. Thrombocytosis: diagnostic evaluation, thrombotic risk stratification, and risk-based management strategies. Thrombosis. 2011; 2011: 1-16.
[12] Valade N, Decailliot F, Rébufat Y, Heurtematte Y, Duvaldestin P, Stéphan F. Thrombocytosis after trauma: incidence, aetiology, and clinical significance. Br J Anaesth. 2005; 94 (1): 18–23.
[13] Wang JL, Huang LT, Wu KH, Lin HW, Ho MY, Liu HE. Associations of reactive thrombocytosis with clinical characteristics in pediatric diseases. Pediatr Neonatol. 2011; 52 (5): 261–6.
[14] Boddu P, Falchi L, Hosing C, Newberry K, Bose P, Verstovsek S. The role of thrombocytapheresis in the contemporary management of hyperthrombocytosis in myeloproliferative neoplasms: A case-based review. Leuk Res. 2017; 58 (Unit 428): 14–22.
[15] Chia TL, Chesney TR, Isa D, Mnatzakanian G, Colak E, Belmont C, Hirpara D, Veigas PV, Acuna SA, Rizoli S, Rezende-Neto J. Thrombocytosis in splenic trauma: In-hospital course and association with venous thromboembolism. Injury. 2017; 48 (1): 142-7.
[16] Tomer A. Effects of anagrelide on in vivo megakaryocyte proliferation and maturation in essential thrombocythemia. Blood. 2002; 99 (5): 1602–9.
[17] Palandri F, Catani L, Testoni N, Ottaviani E, Polverelli N, Fiacchini M, Fiacchini M, De Vivo A, Salmi F, Lucchesi A, Baccarani M, Vianelli N. Long-term follow-up of 386 consecutive patients with essential thrombocythemia: Safety of cytoreductive therapy. Am J Hematol. 2009; 84 (4): 215–20.
[18] Heeney MM, Ware RE. Hydroxyurea for children with sickle cell disease. Hematol Oncol Clin North Am. 2010 Feb; 24 (1): 199–214.
[19] Greist A. The role of blood component removal in essential and reactive thrombocytosis. Ther Apher. 2002; 6 (1): 36–44.
[20] Chong J, Jones P, Spelman D, et al. Overwhelming post-splenectomy sepsis in patients with asplenia and hyposplenia: a retrospective cohort study. Epidemiol Infect. 2017; 145: 397.
Cite This Article
  • APA Style

    Desmiyati Natalia Adoe, Ketut Ariawati, Aankp Widnyana. (2021). Extreme Reactive Thrombocytosis Post-Splenectomy in 16 Years Old Boy. American Journal of Pediatrics, 7(3), 95-99. https://doi.org/10.11648/j.ajp.20210703.11

    Copy | Download

    ACS Style

    Desmiyati Natalia Adoe; Ketut Ariawati; Aankp Widnyana. Extreme Reactive Thrombocytosis Post-Splenectomy in 16 Years Old Boy. Am. J. Pediatr. 2021, 7(3), 95-99. doi: 10.11648/j.ajp.20210703.11

    Copy | Download

    AMA Style

    Desmiyati Natalia Adoe, Ketut Ariawati, Aankp Widnyana. Extreme Reactive Thrombocytosis Post-Splenectomy in 16 Years Old Boy. Am J Pediatr. 2021;7(3):95-99. doi: 10.11648/j.ajp.20210703.11

    Copy | Download

  • @article{10.11648/j.ajp.20210703.11,
      author = {Desmiyati Natalia Adoe and Ketut Ariawati and Aankp Widnyana},
      title = {Extreme Reactive Thrombocytosis Post-Splenectomy in 16 Years Old Boy},
      journal = {American Journal of Pediatrics},
      volume = {7},
      number = {3},
      pages = {95-99},
      doi = {10.11648/j.ajp.20210703.11},
      url = {https://doi.org/10.11648/j.ajp.20210703.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20210703.11},
      abstract = {Thrombocytosis is a common occurrence in childhood. The most common causes of thrombocytosis are infection, trauma, surgery, and malignancy. Splenectomy may cause reactive thrombocytosis, which affects approximately 75-80% of patients and is associated with an increased risk of thrombotic and hemorrhagic complications. The appearance of thrombocytosis must be diagnosed in order to determine the treatment and prognosis. Antiplatelet agents, cytoreductive therapy, and/or therapeutic apheresis can be used to accomplish this. We reported a 16-year-old male who developed extreme reactive thrombocytosis following splenectomy. He was admitted to the hospital with a grade IV spleen rupture as a result of blunt abdominal trauma and underwent total splenectomy. After splenectomy, his platelet count was 229x109/L and increased to 1154x109/L on the ninth postoperative day. He stated that he was suffering from a fever, headache, fatigue, and abdominal pain. Therefore, he was referred to a consultant pediatric haemato-oncology specialist for thrombocytosis management and was diagnosed with extreme reactive thrombocytosis. Cytoreductive agents such as hydroxyurea were used to treat him. His platelet count decreased to less than 400x109/L after 37 days of treatment. At 1-year follow-up, his complete blood count remains normal. He has been asymptomatic. We concluded that splenectomy may lead to extreme thrombocytosis, resulting in thrombotic and hemorrhagic complications. Thus, physicians should clinically monitor patients to ensure prompt diagnosis and appropriate treatment, as well as to prevent thrombosis and hemorrhage complications.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Extreme Reactive Thrombocytosis Post-Splenectomy in 16 Years Old Boy
    AU  - Desmiyati Natalia Adoe
    AU  - Ketut Ariawati
    AU  - Aankp Widnyana
    Y1  - 2021/06/16
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajp.20210703.11
    DO  - 10.11648/j.ajp.20210703.11
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 95
    EP  - 99
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20210703.11
    AB  - Thrombocytosis is a common occurrence in childhood. The most common causes of thrombocytosis are infection, trauma, surgery, and malignancy. Splenectomy may cause reactive thrombocytosis, which affects approximately 75-80% of patients and is associated with an increased risk of thrombotic and hemorrhagic complications. The appearance of thrombocytosis must be diagnosed in order to determine the treatment and prognosis. Antiplatelet agents, cytoreductive therapy, and/or therapeutic apheresis can be used to accomplish this. We reported a 16-year-old male who developed extreme reactive thrombocytosis following splenectomy. He was admitted to the hospital with a grade IV spleen rupture as a result of blunt abdominal trauma and underwent total splenectomy. After splenectomy, his platelet count was 229x109/L and increased to 1154x109/L on the ninth postoperative day. He stated that he was suffering from a fever, headache, fatigue, and abdominal pain. Therefore, he was referred to a consultant pediatric haemato-oncology specialist for thrombocytosis management and was diagnosed with extreme reactive thrombocytosis. Cytoreductive agents such as hydroxyurea were used to treat him. His platelet count decreased to less than 400x109/L after 37 days of treatment. At 1-year follow-up, his complete blood count remains normal. He has been asymptomatic. We concluded that splenectomy may lead to extreme thrombocytosis, resulting in thrombotic and hemorrhagic complications. Thus, physicians should clinically monitor patients to ensure prompt diagnosis and appropriate treatment, as well as to prevent thrombosis and hemorrhage complications.
    VL  - 7
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Department of Child Health, Faculty of Medicine Udayana University/Sanglah Hospital, Denpasar, Indonesia

  • Department of Child Health, Faculty of Medicine Udayana University/Sanglah Hospital, Denpasar, Indonesia

  • Department of Child Health, Faculty of Medicine Udayana University/Sanglah Hospital, Denpasar, Indonesia

  • Sections