(P-TA-3) Critical Thrombocytosis Following Splenectomy in a Patient with Drug Resistant Idiopathic Thrombocytopenic Purpura 

We investigated a case of a 19-year-old male with bruising and epistaxis who was diagnosed with chronic ITP. He was initially treated with IVIG infusions with only transient response. He was also given trials of Promacta without significant sustained response, and then Neulesta, which provided inadequate, stable response. He continued to receive periodic IVIG infusions, which were tolerated well, but continued to have epistaxis.  

Over the course of the next four months, his dosing of Promacta and Nplate were adjusted with varying results. Due to the variability the patient elected to undergo splenectomy which was performed without any initial complications. Over the next 8 days post operatively his platelet count began to rise, reaching a peak platelet count of 4,223 K/uL. At this time the decision was made to proceed with thrombocytapheresis. 




Results/Findings: We herein describe the presentation, clinical course, treatment and outcome of a patient with a critically high platelet value following treatment with thrombopoietin agonists before splenectomy for idiopathic thrombocytopenic purpura. This patient ultimately required multiple rounds of thrombocytapheresis to reduce his platelet count to an acceptable range.

Conclusions:

Literature on this topic remains mixed, but some studies show that there is the potential for severe thrombotic complications as a result from hyper viscosity related to thrombocytosis. After discussion from a multidisciplinary team and speaking with the patient and his mother regarding the risks and benefits, it was decided to proceed with thrombocytapheresis. 

Thrombocytapheresis may be an effective and necessary solution for rebound thrombocytosis following splenectomy for drug resistant ITP after treatment with thrombopoietin agonists. This case represents a unique event following splenectomy for chronic ITP.