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THE DANGERS OF SURGERY IN UNCONTROLLED HAEMORRHAGIC THROMBOCYTHAEMIA
Author(s) -
Ravich R. B. M.,
Gunz F. W.,
Reed C. S.,
Thompson I. L.
Publication year - 1970
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1970.tb116870.x
Subject(s) - medicine , splenectomy , platelet , surgery , exacerbation , thrombosis , heparin , incidence (geometry) , spleen , physics , optics
Surgery, and particularly splenectomy, performed on patients with undiagnosed or untreated hæmorrhagic thrombocythæmia is an extremely hazardous procedure. Postoperatively, further elevation of an already high number of abnormal platelets causes severe and life‐threatening exacerbation of the thromboembolic phenomena and hæmorrhagic episodes which are characteristic of this disorder. Once diagnosed, treatment of the condition is relatively easy with the use of radioactive phosphorus ( 32 P) or busulphan to decrease the number of platelets in between two and four weeks. Surgery, if required, should be delayed until the platelet count is below 500,000/mm 3 , in order to reduce the risk of postoperative thrombosis and haemorrhage, which are directly related to the height of the platelet count. One case of hæmorrhagic thrombocythæmia which was correctly diagnosed and treated is presented, together with two other cases, in which gastrectomy and splenectomy respectively were carried out before diagnosis in the presence of a very high platelet count. The severe postoperative complications are described, together with difficulties encountered in controlling the abnormal coagulation state with heparin. Attention is drawn to the high incidence of peptic ulceration in this condition, which may lead to surgical intervention before diagnosis.