A CASE OF HEMOLYTIC UREMIC SYNDROME (HUS) ASSOCIATED WITH THROMBOCYTOSIS AFTER SPLENECTOMY

Abstract

A 23-year-old woman underwent a total splenectomy for rupture of the spleen due to a trafficaccident. On admission, a mild thrombocytosis was noted and the resected spleen was 147g in weight, showing a slight splenoma. After the operation, thrombocytosis became prominent and aspirin and dipyridamole were administerted to prevent thrombosis, but the platelet count increased to 1, 950, 000/mm8 on the 14th hospital day. On the 31st postoperative day, hemoglobinuria appeared abruptly, and relative thrombocytopenia, high level of LDH, increase in BUN, and appearance of clastic erythrocytes were confirmed. The patient was diagnosed as hemolytic uremic syndrome (HUS). HUS was successfully managed by administration of ticlopidine and heparin while it stayed in a relatively mild state. As of 3 months after the operation, however, the platelet count is still kept at high level, around 1, 200, 000/mm8 and antiplatelet regimen is still continued. No case of HUS caused by thrombocytosis has been reported as far as we could review, and this case is so rare. In this case, an increase in megakaryocytes was noted in a bone marrow picture. In is thought that underlying primary thrombocytosis might cause this abnormal increase in platelets.