Life-threatening hypercoagulable state following splenectomy in ITP

Successful management with aggressive antithrombotic therapy and danazol

Maike P. Tiede, Eugene R. Ahn, Wenche Jy, Thomas Scagnelli, Carlos J. Bidot, Lawrence L. Horstman, Joaquin J Jimenez, Yeon Ahn

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

A life-threatening hypercoagulable state (HCS) is reported that developed after splenectomy in idiopathic thrombocytopenic purpura (ITP). A 50-year-old active male was rejected for blood donation because of an incidental finding of low platelet counts, 40,000/uL. The diagnosis was ITP. Although asymptomatic, he underwent splenectomy because of poor response to steroids and intravenous (IV) gamma globulin. One month after splenectomy, he suffered pulmonary emboli without deep venous embolism (DVT), followed by bilateral DVT, threatening amputation of the legs. Emergency thrombolysis, insertion of stent, and IV heparin saved his legs. Extensive workup for HCS was negative. IV heparin was witheld for colonoscopy for possible gastrointestinal neoplasm, at which time DVT recurred, necessitating another thrombolysis and heparin infusion. He was discharged on enoxaparin, antiplatelet therapy, and danazol. Platelet hyperactivation, characterized by high platelet microparticles (PMP) and CD62P, was present throughout his course of active ITP, resolving when FTP went into remission with danazol therapy. ITP has remained in remission for 4 years after stopping enoxaparin and danazol. In vitro, his plasma in active ITP induced activation of normal platelets, generating PMP and inducing CD62p-positive platelets and platelet aggregates; his plasma from remission had no effect. This indicates the presence of a platelet activating factor, possibly anti-platelet antibodies. Splenectomy may have allowed procoagulant PMP to accumulate to high levels resulting in HCS. We advise awareness of thrombotic complications post-splenectomy in the subset of ITP patients who are largely asymptomatic and exhibit persisting platelet activation.

Original languageEnglish
Pages (from-to)347-352
Number of pages6
JournalClinical and Applied Thrombosis/Hemostasis
Volume11
Issue number3
DOIs
StatePublished - Jul 1 2005

Fingerprint

Danazol
Idiopathic Thrombocytopenic Purpura
Splenectomy
Blood Platelets
Heparin
Enoxaparin
Platelet Activation
Embolism
Therapeutics
Leg
Incidental Findings
Gastrointestinal Neoplasms
Platelet Activating Factor
gamma-Globulins
Colonoscopy
Blood Donors
Platelet Count
Amputation
Stents
Anti-Idiotypic Antibodies

Keywords

  • Danazol
  • Hypercoagulable state
  • Idiopathic thrombocytopenic purpura
  • Splenectomy

ASJC Scopus subject areas

  • Hematology

Cite this

Life-threatening hypercoagulable state following splenectomy in ITP : Successful management with aggressive antithrombotic therapy and danazol. / Tiede, Maike P.; Ahn, Eugene R.; Jy, Wenche; Scagnelli, Thomas; Bidot, Carlos J.; Horstman, Lawrence L.; Jimenez, Joaquin J; Ahn, Yeon.

In: Clinical and Applied Thrombosis/Hemostasis, Vol. 11, No. 3, 01.07.2005, p. 347-352.

Research output: Contribution to journalArticle

Tiede, Maike P. ; Ahn, Eugene R. ; Jy, Wenche ; Scagnelli, Thomas ; Bidot, Carlos J. ; Horstman, Lawrence L. ; Jimenez, Joaquin J ; Ahn, Yeon. / Life-threatening hypercoagulable state following splenectomy in ITP : Successful management with aggressive antithrombotic therapy and danazol. In: Clinical and Applied Thrombosis/Hemostasis. 2005 ; Vol. 11, No. 3. pp. 347-352.
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