Journal List > Korean J Hematol > v.44(4) > 1032852

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

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.

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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).
kjh-44-298f1.tif
Fig. 2.
Abdominopelvic computed tomography shows subtle high density in gall bladder suggesting GB stone and splenomegaley of 155 mm.
kjh-44-298f2.tif
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.
kjh-44-298f3.tif
Table 1.
Characteristics of blood count in relation to hospital course
  Admission Postoperative duration (months)
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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