Prolonged Extreme Thrombocytosis in a Postsplenectomy Patient with Hereditary Spherocytosis

Yae Min Park; Jinny Park; Yunjeong Jo; Sei-Hyun Kim; Kwen-Chul Shin; In Sik Won; Sun Jin Sym; Eun Kyung Cho; Dong Bok Shin; Jae Hoon Lee

doi:10.5045/kjh.2009.44.4.298

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Park, Park, Jo, Kim, Shin, Won, Sym, Cho, Shin, and Lee: Prolonged Extreme Thrombocytosis in a Postsplenectomy Patient with Hereditary Spherocytosis

Case Report

Korean J Hematol 2009;44(4):298-303.

Published online: 20 December 2009

DOI: https://doi.org/10.5045/kjh.2009.44.4.298

Prolonged Extreme Thrombocytosis in a Postsplenectomy Patient with Hereditary Spherocytosis

Yae Min Park, M.D., Jinny Park, M.D., Ph.D., Yunjeong Jo, M.D., Sei-Hyun Kim, M.D., Kwen-Chul Shin, M.D., In Sik Won, M.D., Sun Jin Sym, M.D., Eun Kyung Cho, M.D., Ph.D., Dong Bok Shin, M.D., Ph.D., Jae Hoon Lee, M.D., Ph.D.

Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital, Incheon, Korea

Correspondence to：Jinny Park, M.D., Ph.D. Department of Internal Medicine, Gachon University of Medicine and Science, Gil Hospital 1198, Guwol-dong, Namdong-gu, Incheon 405-780, Korea Tel: ＋82-32-460-8209, Fax: ＋82-32-432-4355 E-mail: jhagnes@gilhospital.com

Received 29 August 2009 Revised 7 December 2009 Accepted 10 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of prolonged extreme reactive thrombocytosis in a post-splenectomy patient with hereditary spherocytosis. A 29-year-old female patient presented with gall stones detected incidentally by abdominal ultrasonography. Her laboratory findings showed hemolytic anemia with spherocytosis on the peripheral blood smear and increased osmotic fragility. She was diagnosed with hereditary spherocytosis and underwent a laparoscopic cholecystectomy and splenectomy. After undergoing surgery, the hemolytic anemia was resolved but thrombocytosis was newly detected. Nineteen months after the splenectomy, the thrombocytosis was still persistent and extremely high. To our knowledge, this is the first report of a prolonged extreme reactive thrombocytosis after a splenectomy in Korea.

Keywords: Reactive thrombocytosis, Postsplenectomy, Hereditary spherocytosis

References

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Fig. 1.

Peripheral blood smear shows normocytic normochromic anemia with spherocytes which are small hyperchromatic cells without the usual clear area in the center (Wright stain, ×400).

Fig. 2.

Abdominopelvic computed tomography shows subtle high density in gall bladder suggesting GB stone and splenomegaley of 155 mm.

Fig. 3.

The platelet count was increased after splenectomy. After the anagrelide therapy, the count was decreased, but after the discontinuation of the anagrelide therapy, it began to increase again. 19 months after having underwent splenectomy, extreme thrombocytosis is persistent.

Table 1.

Characteristics of blood count in relation to hospital course

	Admission	Postoperative duration (months)
	Admission	0.5	1	2	4	6	8	10	12	14	16	18
PLT (X10⁹/L)	374	1,496	718	839	867	584	947	739	773	1,021	940	1,051
WBC (×10⁹/L)	11.54	8.59	18.03	16.50	16.61	15.96	18.05	16.23	14.60	17.61	16.12	11.29
Hb (g/dL)	10	12	13.2	13.9	13.5	13.4	13.8	13.1	13.2	12.5	37.2	37.9
Hct (%)	27.7	40.3	39.8	40.8	38.9	40.6	42.3	41.0	40.0	40.4	11.1	11.3

Abbreviations: PLT, platelet; WBC, white blood cell; Hb, hemoglobine; Hct, hematocrete.

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