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.

The relationship between knee adduction moment and cartilage and meniscus morphology in women with osteoarthritis

“…Although, the sample size for the lateral OA group was relatively small these results could motivate further research in this subgroup. The magnitude of the knee adduction moment reported in the current study is somewhat lower than the values found in the literature for patients with medial OA 7,33,39,40 . We believe that two factors contribute to the lower peak knee adduction moment.…”

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

“…9 A study by Wada et al reported a patient with ET receiving cholecystectomy and choledochotomy at thrombocyte level of 1,302,000/mm 3 . 10 The patient experienced 40 mg intraoperative bleeding, which was then given low molecular weight heparin (LMWH) on postoperative care. However, the patient experienced a bloody discharge from intra-abdominal drainage and was then reoperated for hemostasis.…”

“…However, the patient experienced a bloody discharge from intra-abdominal drainage and was then reoperated for hemostasis. 10 Even though patients with high platelet counts are at high risk of thrombosis, platelet count and thrombosis may not be linearly related in patients with MPN. Surgery and recent COVID infection could increase platelet count, but reactive conditions were associated with risk of venous thrombosis in both non-MPN and MPN patients.…”

Incidental thrombocytosis: Should it concern the anesthesiologist?

“…[1489] These included maintaining good hydration to decrease the hyperviscosity due to a high PC, ensuring early postoperative ambulation, use of mechanical thromboprophylaxis methods like compression stockings and pneumatic compression devices, and, pharmacological thromboprophylaxis with low molecular weight and unfractionated heparin, warfarin, and aspirin; though pharmacological methods have been used during major surgery in high risk ET patients, it requires caution due to the risk of enhanced bleeding. [210] Intra-and postoperative administration of gabexate mesilate, an antiplatelet agent, has also been reported to prevent thrombotic complications. [11] Surgical blood loss and postoperative infection may result in worsening of thrombocytosis and should be promptly managed.…”