Thrombocytosis

In the immediate postoperative period in uncomplicated splenectomy patients, the platelet count rises steeply to a maximum of usually 600-1000 X 109/L, with a peak at 7-12 days. In a number of patients, the thrombocytosis persists indefinitely after splenectomy. This usually appears to be a consequence of continuing anaemia with a hyperplastic marrow; an inverse relationship exists between the severity of the anaemia and the height of the platelet counts. Although a reactive thrombocytosis is not usually associated with thromboembolic problems, the high platelet counts may have contributed to the serious and sometimes fatal episodes of pulmonary embolism that have occurred following splenectomy. Mesenteric infarction secondary to partial vein occlusion is more common in patients with myeloproliferative disorders who undergo splenectomy. Postoperative prophylaxis with heparin is usually needed. It is advisable to give antiplatelet therapy (e.g. aspirin 75 mg daily) as long as thrombocytosis is present.

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