Abstract
Thrombocytosis is a common occurrence in childhood. The most common causes of thrombocytosis are infection, trauma, surgery, and malignancy. Splenectomy may cause reactive thrombocytosis, which affects approximately 75-80% of patients and is associated with an increased risk of thrombotic and hemorrhagic complications. The appearance of thrombocytosis must be diagnosed in order to determine the treatment and prognosis. Antiplatelet agents, cytoreductive therapy, and/or therapeutic apheresis can be used to accomplish this. We reported a 16-year-old male who developed extreme reactive thrombocytosis following splenectomy. He was admitted to the hospital with a grade IV spleen rupture as a result of blunt abdominal trauma and underwent total splenectomy. After splenectomy, his platelet count was 229x10<sup>9</sup>/L and increased to 1154x10<sup>9</sup>/L on the ninth postoperative day. He stated that he was suffering from a fever, headache, fatigue, and abdominal pain. Therefore, he was referred to a consultant pediatric haemato-oncology specialist for thrombocytosis management and was diagnosed with extreme reactive thrombocytosis. Cytoreductive agents such as hydroxyurea were used to treat him. His platelet count decreased to less than 400x10<sup>9</sup>/L after 37 days of treatment. At 1-year follow-up, his complete blood count remains normal. He has been asymptomatic. We concluded that splenectomy may lead to extreme thrombocytosis, resulting in thrombotic and hemorrhagic complications. Thus, physicians should clinically monitor patients to ensure prompt diagnosis and appropriate treatment, as well as to prevent thrombosis and hemorrhage complications.
Highlights
The spleen and liver are the most frequently injured intra-abdominal organs in traffic accidents, followed by falls from elevated heights, bicycle accidents, and child abuse
Splenectomy can lead in reactive thrombocytosis, which occurs in approximately 75-80% of patients
Post-splenectomy venous thrombosis is typically associated with platelet counts between 600 and 800x109/L and affects approximately 5% of patients [7]
Summary
The spleen and liver are the most frequently injured intra-abdominal organs in traffic accidents, followed by falls from elevated heights, bicycle accidents, and child abuse. Post-splenectomy venous thrombosis is typically associated with platelet counts between 600 and 800x109/L and affects approximately 5% of patients [7]. When the platelet count is greater than 500 x109/L, prophylactic anticoagulants are indicated to prevent thrombosis and hemorrhage in reactive thrombocytosis. Patients with extreme thrombocytosis and evidence of arterial or venous thrombosis may require cytoreductive agents such as hydroxyurea or anagrelide, and with regular platelet count monitoring [7, 8]. Due to the fact that the integrity of the splenic capsule was disrupted on the renal surface and a 3 to 5 cm splenic laceration with subcapsular hematoma was observed, he underwent total splenectomy (Figure 1) He was diagnosed as ruptured spleen grade IV, generalized peritonitis caused by blunt abdominal trauma, intra-abdominal bleeding
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