Anesthetic Management of a Patient with Reactive Thrombocytosis due to Post-Trauma Splenectomy in a Patient Requiring Further Corrective Surgeries: A Case Report

Thrombocytosis poses hemostatic and bleeding risks, especially in the perioperative period and in the presence of other risk factors. There is no defined upper cut-off limit for platelet count for elective surgeries and ideal mode of anesthesia in these patients, especially in reactive thrombocytosis. A 22-year-old male will be described with thrombocytosis post-splenectomy after trauma and was scheduled to undergo an open reduction and internal fixation (ORIF) procedure for the shaft of a femur fracture. Hematology evaluation was sought and the decision to go ahead with the surgery was taken since the patient had no symptoms or signs of thrombosis or bleeding and the surgery was urgent which would help the patient to mobilize early and prevent further risk. Informed written risk consent was obtained from the patient about the risk of thromboembolism perioperatively. Perioperative measures for thromboprophylaxis were taken and the procedure was done uneventfully under spinal anesthesia. Postoperatively Hydroxyurea was started and after an uneventful hospital course, he was discharged and asked to follow up in the hematology outpatient department (OPD). There are conflicts on the use of neuraxial anesthesia in patients with thrombocytosis. The risk of bleeding and thrombosis is considerably less in reactive etiology and hence we decided to go ahead with spinal anesthesia. Also, none of the studies have defined the upper safe limit of platelet count that is to be accepted for elective surgeries. Further studies are needed in patients with thrombocytosis undergoing urgent or emergent surgeries where deferring surgeries for optimizing platelet count is not an option to understand the risks associated and the suitable method of anesthesia.