Severe Post-Splenectomy Reactive Thrombocytosis with Active Bleeding: A Case Report

Abstract

Background. Post-splenectomy reactive thrombocytosis is a well-documented complication, but its management becomes particularly challenging when complicated by active bleeding. This case presents a unique therapeutic dilemma where conventional platelet-lowering interventions were contraindicated due to ongoing hemorrhage, necessitating a carefully balanced management approach.

Case Presentation. A 30-year-old female presented with blunt abdominal trauma following a motorcycle accident, requiring emergency splenectomy for splenic rupture. Post-operatively, she developed severe reactive thrombocytosis with platelet counts reaching 945,000/μL by day 14, complicated by active bleeding manifesting as hematuria. The patient also sustained multiple injuries including left kidney trauma, rib fractures, and vertebral fractures, adding complexity to the management approach.

Management and Outcomes. Conservative management was adopted, prioritizing hemorrhage control over immediate platelet reduction. Serial monitoring demonstrated a gradual decline in platelet counts from 945,000/μL to 535,000/μL over one week without pharmacological intervention. Blood smear analysis confirmed reactive thrombocytosis, effectively ruling out myeloproliferative disorders. The patient remained stable throughout the observation period without developing thrombotic complications.

Conclusions. This case demonstrates that severe post-splenectomy thrombocytosis can be successfully managed conservatively in the presence of active bleeding through careful monitoring and individualized risk assessment. The natural resolution of thrombocytosis without pharmacological intervention suggests that aggressive platelet reduction may not always be necessary when close surveillance is maintained.