A 23-year-old man is brought by helicopter to a major trauma center after a severe motorcycle accident. He has major abdominal trauma, including a ruptured spleen, and is taken to surgery, where his spleen is removed
Two weeks after surgery, his platelet count peaks at 950 x 109/L. What is the most likely cause for this high platelet count?
a. Reactive thrombocytosis secondary to trauma
b. Essential thrombocythemia
c. Postsplenectomy thrombocytosis
d. Reactive thrombocytosis secondary to acute blood loss
ANS: C
Removal of the spleen characteristically results in a thrombocytosis that can reach or even exceed 1000 x 109/L (1 million/mL). The platelet count usually peaks 2 to 3 weeks after surgery and generally remains elevated for 1 to 3 months. Platelet counts generally are not this elevated in reactive thrombocytosis, and they do not peak 2 to 3 weeks after surgery.
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