Extreme Thrombocytosis after Pediatric Pancreatectomy with Islet Autotransplantation Is Unique Compared to Other Postsplenectomy States
| Autor: | Joseph S. Palumbo, Tom K. Lin, Jaimie D. Nathan, Jose A. Cancelas, Todd M. Jenkins, Alexander A. Boucher, Lori Luchtman-Jones, Maisam Abu-El-Haija |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Splenectomy Islets of Langerhans Transplantation Transplantation Autologous Gastroenterology 03 medical and health sciences Pancreatectomy 0302 clinical medicine 030225 pediatrics Internal medicine medicine Humans Child Retrospective Studies Thrombocytosis business.industry Incidence Incidence (epidemiology) General Medicine medicine.disease Autotransplantation 030220 oncology & carcinogenesis Relative risk Pediatrics Perinatology and Child Health Cohort Surgery business Cohort study |
| Zdroj: | Journal of Pediatric Surgery. 55:1645-1650 |
| ISSN: | 0022-3468 |
| Popis: | 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.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.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.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.Treatment study, Level III (retrospective comparative study). |
| Databáze: | OpenAIRE |
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