Surgery for Cholecystocholedocholithiasis in a Patient with Asymptomatic Essential Thrombocythemia: Report of a Case

Abstract

Essential thrombocythemia (ET) is a myeloproliferative disorder characterized by a remarkable increase in the platelet count and various clinical symptoms. The perioperative management of patients with ET has yet to be determined, especially when there are no clinical symptoms. We report herein the case of a woman with gallstones whose preoperative hematological data showed remarkable thrombocythemia, but her coagulation studies were normal. The Philadelphia chromosome was negative and bone marrow cytology showed a marked increase in megakaryocytes. Surgery was performed under a diagnosis of cholelithiasis with ET. Considering her severe thrombocythemia and obesity, sufficient heparin was administered to prevent deep vein thrombosis; however, this precipitated postoperative bleeding, necessitating a reoperation. A functional abnormality of the patient's platelets was suspected, and the aggregation by adenosine diphosphate was subsequently found to be significantly inhibited. As patients having ET with no symptoms might have depressed platelet aggregability despite remarkable thrombocythemia, when abdominal surgery is performed, prophylactic therapy for deep vein thrombosis should be avoided. Hence, the preoperative aggregation study of platelets might offer useful information about whether postoperative antithrombotic therapy is indicated.

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

“…Perioperative data. Case report reference Year of publication Age/sex Surgery performed Esplenomegaly Previous complication Medical treatment Preoperative platelet count (×10 3 /L) Perioperative thromboprofilaxis Postoperative complication Management of complication Wada [12] 1998 52/F Cholecystectomy and choledochotomy Yes None None 1300 Low molecular weight heparin, ceased after bleeding Abdominal bleeding (Drain insertion wound) Reoperation for hemostasis and intaabdominal hematoma evacuation Cai [13] 2009 36/F Splenectomy and mesocaval shunt with prosthetic graft Yes Previous history of vascular thrombosis None 313 Low-dose heparin. When platelet count increased to 113710 9 L 1 , aspirin commenced Pseudohyperkalemia None Amarapukar [14] 2013 38/F Laparoscopic cholecystectomy Yes Hematemesis None 280 Low molecular weight heparin after thrombosis diagnosed Budd-Chiari syndrome (1. hepatic venous thrombosis with occlusion of all the three veins and a pat- ent portal venous system) 2. angioplasty thromobsis 1.…”

“…Only seven abdominal surgery cases with an associated ET diagnosis have been reported [12] , [13] , [14] , [15] , [16] , [17] , 4 of them presenting bleeding as a postoperative complication. Currently, there are no perioperative indications for emergency plateletpheresis, thromboprophylaxis, or suspension of previous treatments.…”