Incidental thrombocytosis: Should it concern the anesthesiologist?

Kiro, Kiranlata; Ganjoo, Pragati; Saigal, Deepti; Hansda, Upendra

doi:10.4103/0970-9185.130102

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…While the etiology of thrombocytosis was unknown, reactive thrombocytosis is the leading cause of thrombocytosis in the general medical population and usually occurs as a result of an acute phase response to infection or tissue damage. 7 , 21 , 22 Prior studies found that infected patients may present with thrombocytosis even in the absence of other more obvious signs of infection such as an elevated white blood cell count or fever. 23 , 24 In agreement with the literature in other patient populations, 8 - 10 our findings suggest that thrombocytosis may be a clinical indicator of postoperative infection risk in hip fracture patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with Preoperative Thrombocytosis After Hip Fracture Surgery

Gonzalez,

Van Rysselberghe,

Maschhoff

et al. 2024

JAAOS Glob Res Rev

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Introduction: Low platelet counts have clinically relevant effects on patient outcomes after hip fracture surgery; however, the relationship between abnormally high platelet counts and postoperative outcomes in this population is unknown. Methods: The ACS-NSQIP database was queried for patients who underwent hip fracture surgery between 2015 and 2019. Outcomes were compared between patients with normal platelet counts (150,000 to 450,000/μL) and thrombocytosis (>450,000/μL). Results: Eighty-six thousand three hundred eleven hip fracture patients were identified, of which 1067 (1.2%) had preoperative thrombocytosis. Compared with patients with normal platelet counts, patients with preoperative thrombocytosis had increased rates of 30-day mortality (6.4% vs 4.5%, P = 0.004; OR 1.15 [95% CI 0.88 to 1.50], P = 0.322) as well as increased rates and odds of readmission (11.4% vs 7.8%, P < 0.001; OR 1.35 [95% CI 1.10 to 1.65], P = 0.004) and venous thromboembolic events (3.2% vs 1.7%, P < 0.001; OR 1.88 [95% CI 1.31 to 2.71], P < 0.001). Conclusions: Hip fracture patients with preoperative thrombocytosis had increased rates of early mortality as well as increased odds of venous thromboembolic events and readmission. A patient with thrombocytosis may benefit from close postoperative surveillance and careful follow-up. Future prospective studies are needed to verify causation and investigate how to mitigate adverse outcomes in hip fracture patients with preoperative thrombocytosis.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with Preoperative Thrombocytosis After Hip Fracture Surgery

Gonzalez,

Van Rysselberghe,

Maschhoff

et al. 2024

JAAOS Glob Res Rev

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“…[ 13 , 14 ] Therefore, caution during preoperative evaluation and treatment to reduce platelet counts are considered to be essential before surgery. [ 15 – 18 ] We chose plateletpheresis to quickly decrease the platelet count, since this has been successfully applied in coronary artery bypass grafting. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Abdominal surgery in patients with essential thrombocythemia

Zhu

Jiang²,

Chen³

et al. 2017

Medicine

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Introduction:Essential thrombocythemia/thrombocytosis (ET) is characterized by increased bleeding and thrombosis risk during the perioperative period. We report the case of a woman with ET and sigmoid colon cancer, in whom the postoperative course was complicated by anastomotic bleeding. A systematic review was conducted to seek guidance for the management of such patient in the perioperative period.Methods:A systematic literature review was conducted using EMBASE, Medline, and PubMed databases to detect relevant English language articles. Published studies with full-text articles were included. Two authors independently searched and extracted the data. Any differences were resolved by consensus. Studies on abdominal surgery were manually retrieved.Results:Four case reports (including our case report) that described abdominal surgery in patients with ET were included. All patients were females, with a mean age of 47 years. Laparoscopic surgery was performed in 2 patients, and open surgery was performed in the other 2 patients. Two patients had postoperative bleeding that occurred on the first postoperative day. There was one case of pseudohyperkalemia after surgery and one case of Budd-Chiari syndrome caused by hepatic vein thrombosis. No guidelines for patients with ET undergoing abdominal surgery were found.Conclusion:In conclusion, there are currently no definitive guidelines for the perioperative management of patients with ET. Furthermore, there are few reports of ET in patients with malignancy undergoing surgery. Further studies in this unique group of patients are required.

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“…Elective surgery should be delayed until platelet counts return to normal levels and any cardiovascular risk factors are addressed. Symptomatic ET patients may require cytoreductive therapy to achieve this, while perioperative thromboprophylaxis may be necessary in emergency cases [ 40 ].…”

Section: Reviewmentioning

confidence: 99%

A Review About the Assessment of the Bleeding and Thrombosis Risk for Patients With Myeloproliferative Neoplasms Scheduled for Surgery

Andreescu,

Andreescu

2024

Cureus

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Myeloproliferative neoplasms (MPNs) present a unique challenge in surgical management due to their inherent predisposition to both bleeding and thrombosis. MPNs are a heterogenous group of acquired clonal conditions. The three classic MPNs are essential thrombocythemia (ET), myelofibrosis (PMF), and polycythemia vera (PV). All subtypes of MPN are associated with both thrombotic and bleeding complications. There are four risk categories for thrombosis in MPN patients: age, thrombosis history, and JAK -2 mutation. They are further classified as very low, low, intermediate, and high risk. The genetic landscape of MPN is fascinating and complex like all myeloid disorders. Bleeding risk can be assessed through leukocytosis, thrombocytosis, acquired von Willebrand syndrome (AVWS), and a previous history of bleeding in a patient. Risk assessment and perioperative management are important aspects of improving the quality of life and preventing complications in surgeries. Preoperative management includes a risk assessment of venous thromboembolism, use of appropriate pharmacological treatment, platelet count control, and correction and cardiovascular risk factors. This review summarizes the assessment of bleeding and thrombosis risk for patients with MPNs scheduled for surgery. Furthermore, this review discusses various tools that can be used to identify MPN patients at risk of thrombosis prior to surgery.

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Incidental thrombocytosis: Should it concern the anesthesiologist?

Cited by 6 publications

References 7 publications

Outcomes of Patients with Preoperative Thrombocytosis After Hip Fracture Surgery

Outcomes of Patients with Preoperative Thrombocytosis After Hip Fracture Surgery

Abdominal surgery in patients with essential thrombocythemia

A Review About the Assessment of the Bleeding and Thrombosis Risk for Patients With Myeloproliferative Neoplasms Scheduled for Surgery

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