Postsplenectomy Thrombocytosis

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Abstract
After splenectomy, 2 patients had thromboembolic complications apparently related to their thrombocytosis; a third had hemorrhagic manifestations. Coagulation studies performed on the patients with thromboembolic difficulties revealed no abnormalities except for platelet counts which had risen from normal pre-operative levels to as high as 1.37 x 106 post-operatively. Both patients had multiple pulmonary infarctions. Both symptoms and platelet levels were well controlled with small doses of uracil mustard. The patient with hemorrhagic manifestations showed abnormalities in thromboplastin generation partially corrected by normal serum, alumina absorbed plasma, and dilution of the patient''s platelets. At this time, the platelet count was 2.64 x 106/mm3. Following therapy with uracil mustard, the platelet count fell to normal levels and the thromboplastin generation test reverted to normal. Concomitant with this, the patient became asymptomatic. There are several points of interest in regard to this group of patients. (1) Although the usual postoperative thrombocytosis occurs from 10 to 21 days postoperatively, only one of these patients had difficulties at this time. The others began having symptoms weeks to years after splenectomy. (2) Two underwent splenectomy for hemolytic anemia. (3) The optimum management of this complication includes the use of heparin if the patient is severely ill, followed by an alkylating agent, to maintain the platelet level at a desirable point. In our experience, uracil mustard, because of its thrombocytopenic effect, is an excellent agent for this purpose. In any patient who has ever undergone splenectomy, the occurrence of hemorrhagic or thromboembolic manifestations should cause one to consider the existence of postsplenectomy thrombocytosis.