Extreme Thrombocytosis after Pediatric Pancreatectomy with Islet Autotransplantation Is Unique Compared to Other Postsplenectomy States

Alexander A. Boucher, Lori Luchtman-Jones, Joseph S. Palumbo, Jose A. Cancelas, Maisam Abu-El-Haija, Todd M. Jenkins, Tom K. Lin, Jaimie D. Nathan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Hematologic trends after pancreatectomy with islet autotransplantation (IAT), which involves splenectomy, have been rarely studied. Reactive thrombocytosis (RT, platelets ≥ 500 K/μL) often occurs postoperatively, similar to other postsplenectomy states, but the degree of similarities and true incidence are unknown. Study design: A single-site, retrospective, observational cohort study of patients who underwent total splenectomy between 2010 and 2018 was performed. Thrombocytosis incidence and pharmacologic management strategies were evaluated, including cohort-based analyses for IAT versus other splenectomy indications. Results: Analyses included 112 patients overall, 42 of whom underwent IAT. RT occurred frequently (93.8%) despite most patients having normal preoperative platelet counts. IAT patients had significantly higher peak platelet counts compared to non-IAT patients and the rate of platelet rise for IAT patients was significantly faster. IAT was uniquely predictive of developing extreme thrombocytosis (ExT, platelets ≥ 1000 K/μL, 90% vs. 15.7%, risk ratio 4.11, P < 0.0001) despite standardized hydroxyurea use. Thrombotic events were infrequent and did not differ between groups. Conclusions: RT was common regardless of splenectomy indication but ExT was uniquely associated with IAT despite cytoreductive pharmacotherapy. These results strongly suggest that splenectomy is unlikely to be the sole contributor to post-IAT RT but further investigations into this phenomenon are needed. Level-of-Evidence rating: Treatment study, Level III (retrospective comparative study).

Original languageEnglish (US)
Pages (from-to)1645-1650
Number of pages6
JournalJournal of Pediatric Surgery
Volume55
Issue number8
DOIs
StatePublished - Aug 2020
Externally publishedYes

Bibliographical note

Funding Information:
None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Keywords

  • Pancreatectomy with islet autotransplantation
  • Pediatric
  • Splenectomy
  • Thrombocytosis

PubMed: MeSH publication types

  • Journal Article
  • Observational Study

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