Journal List > J Korean Rheum Assoc > v.17(4) > 1003768

Kim, Lee, Chang, Kwac, Kim, Cha, Choi, and Park: Thrombosis after a Splenectomy in a Patient with Systemic Lupus Erythematosus-related Thrombocytopenia

Abstract

Systemic lupus erythematosus (SLE) is a multisystemic inflammatory autoimmune disease mediated by autoantibodies and immune complexes. In SLE, a splenectomy to control the thrombocytopenia does not increase the total risk of thrombosis, but tends to increase arterial events. We experienced a patient with lupus- anticoagulant positive SLE who developed a venous thrombosis after a splenectomy for the control of thrombocytopenia, which was a very rare case.

REFERENCES

1). Mok CC., Tang SS., To CH., Petri M. Incidence and risk factors of thromboembolism in systemic lupus erythematosus: a comparison of three ethnic groups. Arthritis Rheum. 2005. 52:2774–82.
crossref
2). FrostegaRrd J. SLE, atherosclerosis and cardiovascular disease. J Intern Med. 2005. 257:485–95.
crossref
3). Rabinowitz Y., Dameshek W. Systemic lupus erythematosus after “idiopathic” thrombocytopenic purpura: a review. Ann Intern Med. 1960. 52:1–28.
crossref
4). Diz-KuUcLuUkkaya R., Hacihanefiogblu A., Yenerel M., Turgut M., Keskin H., NalcLaci M, et al. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. Blood. 2001. 98:1760–4.
5). Lavalle C., Hurtado R., Quezada JJ., Cabral A., Fraga A. Hemocytopenia as initial manifestation of systemic lupus erythematosus. Prognostic significance. Clin Rheumatol. 1983. 2:227–32.
crossref
6). Krauth MT., Lechner K., Neugebauer EA., Pabinger I. The postoperative splenic/portal vein thrombosis after splenectomy and its prevention-an unresolved issue. Haematologica. 2008. 93:1227–32.
7). Burgos PI., AlarcoAn GS. Thrombosis in systemic lupus erythematosus: risk and protection. Expert Rev Cardiovasc Ther. 2009. 7:1541–9.
crossref
8). Cappellini MD., Crespi E., Cassinerio E., Bignamini D., Fiorelli G. Coagulation and Splenectomy: an Overview. Ann NY Acad Sci. 2005. 1054:317–24.
crossref
9). Delgado Alves J., Inanc M., Diz-Kucukkaya R., Grima B., Soromenho F., Isenberg DA. Thrombotic risk in patients submitted to splenectomy for systemic lupus erythematosus and antiphospholipid antibody syndrome-related thrombocytopenia. Eur J Intern Med. 2004. 15:162–7.
crossref
10). Ballerini G., Gemmati D., Moratelli S., Morelli P., Serino ML. Anticardiolipin antibody-related thrombocytopenia: persistent remission after splenectomy. Haematologica. 1995. 80:248–51.
11). Wahl DG., Bounameaux H., de Moerloose P., Sarasin FP. Prophylactic antithrombotic therapy for patients with systemic lupus erythematosus with or without antiphospholipid antibodies: do the benefits outweigh the risks? A decision analysis. Arch Intern Med. 2000. 160:2042–8.
12). Erkan D., Yazici Y., Peterson MG., Sammaritano L., Lockshin MD. A cross-sectional study of clinical thrombotic risk factors and preventive treatments in antiphospholipid syndrome. Rheumatology. 2002. 41:924–9.
crossref
13). Rand JH., Wu XX., Quinn AS., Ashton AW., Chen PP., Hathcock JJ, et al. Hydroxychloroquine protects the annexin A5 anticoagulant shield from disruption by antiphospholipid antibodies: evidence for a novel effect for an old antimalarial drug. Blood. 2010. 115:2292–9.
crossref

Fig. 1.
Contrast enhanced abdominal pelvic computed tomography scan on the first day. (A) Portal vein with low attenuated thrombus (white arrow). (B) Enlarged superior mesenteric vein (white arrow) and splenic vein (black arrow) with low attenuation representing an intraluminal thrombus.
jkra-17-442f1.tif
Fig. 2.
Contrast enhanced abdominal pelvic computed tomography scan after anticoagulation treatment for 1 week shows a decreased thrombus size in the portal vein (white arrow) (A), superior mesenteric vein (white arrow), and splenic vein (black arrow) (B). Multiple collateral vessels are noted at the pericholedochal area.
jkra-17-442f2.tif
Fig. 3.
Change in the platelet countsand aPTT before and after the splenectomy. aPTT: activated partial thromboplastin time.
jkra-17-442f3.tif
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