Postoperative bleeding in essential thrombocytosis patients with colorectal cancer: Case report and literature review

Abstract

Introduction and importance Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by increased platelet count and a high risk of bleeding or thrombotic events due to platelet dysfunction. Patients with ET are treated according to their risk of complications with cytoreductive or anti-aggregant treatment. Neither guidelines for oncologic patients nor perioperative management of patients with ET have been determined. Case presentation A 41-year-old female patient with ET who had alternating constipation and diarrhea was referred after a screening colonoscopy diagnosing a locally advanced rectosigmoid junction colon adenocarcinoma with liver metastases. Systemic preoperative chemotherapy was indicated. The patient underwent laparoscopic low anterior resection plus volume-preserving right lobectomy of the liver. Postoperative bleeding of the internal iliac artery (IIA) associated with hematoma at the lower pelvic cavity was diagnosed and treated by interventional radiology; the patient was discharged without other complications 16 days after surgery. Clinical discussion ET has been related to the development of hematologic complications or second non-hematologic malignancies. A systematic review was conducted to seek guidance for the management of such patients in the perioperative period. Special perioperative care must be taken, and complications management should avoid further hemorrhages or cloth formation. Conclusion Under oncologic and hematological guidance, minimally invasive surgery and non-invasive management of complications are advised in the lack of published perioperative management guidelines of ET patients with colorectal cancer.

Surgical Complications in Myeloproliferative Neoplasm Patient with Essential Thrombocythemia: A Case Report

“…The patient was hospitalized for 16 days and did not show any new sign of bleeding or thrombosis. 15 These findings were similar with a finding from a case series by Gurrieri et al which suggested thrombocyte count above 800,000/mm 3 was associated with an increased risk of thrombotic complications. 16 The same study suggested that operations were considered safer in patients with thrombocyte count below 450.000/mm 3 , within which 12% of patients receiving plateletpheresis had complications.…”

“…The patient was given hydroxyurea 0.5 mg, agrylin 1 mg BID, and aspirin 100 mg OD, who was further admitted for operation on thrombocyte level of 920,000/mm 3 . 15 Laparoscopic was conducted without complications, but there was tachycardia with bleeding of the anterior branch of the right internal iliac artery in CT scan; hence, reoperation for embolization was performed. The patient was hospitalized for 16 days and did not show any new sign of bleeding or thrombosis.…”

A Case Report on the Utilization of a Hemostasis Analyzer System in the Management of a Patient With Essential Thrombocythemia

“…Three weeks after surgery, the patient developed anemia due to lower gastrointestinal bleeding [ 7 ]. With a therapeutic range PT-INR and stable platelet count, this event was more likely attributable to an ascending colon diverticulum than to ET or postoperative sequelae.…”

A Comprehensive Study on the Anti-cancer Effects of Quercetin and Its Epigenetic Modifications in Arresting Progression of Colon Cancer Cell Proliferation

“…Despite significant advances in modern colon cancer treatments, such as surgical resection, radiotherapy, and chemotherapy, patients still need more advanced Prognosis and newer treatment strategies (Najafi et al 2021 ; Podda et al 2021 ). Surgical resection in colon cancer patients is a complex procedure with a greater risk of side effects such as pain, excessive bleeding, slow recovery, and recurrent infection (Varela et al 2021 ). Likewise, chemotherapeutic drugs adversely affect the patient’s bone marrow, hair follicles, kidneys, lungs, and nervous system.…”