2018 Volume 51 Issue 5 Pages 380-386
Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an elevated platelet count. It can lead to thrombosis or bleeding and is a risk factor for patients who require surgery. We report a case of advanced rectal cancer complicated by ET, which required preoperative platelet apheresis. A 46-year-old man with a history of platelet count elevation presented with melena and perianal pain, and was given a diagnosis of advanced rectal cancer with multiple liver metastases. Perianal abscess was also diagnosed, which was treated with incision and drainage. On admission, his platelet count was 1,833×103/μl and the bone marrow biopsy results were consistent with our diagnosis of ET. We started hydroxyurea therapy of 1,500 mg, which we increased to 2,500 mg due to the marked elevation in platelet count. However, this therapy was ineffective, with the measured platelet count remaining at 1,182×103/μl. In consideration of the risk of perioperative thrombosis and hemorrhage, we decided on platelet apheresis in order to reduce the platelet count to less than 400×103/μl. After two cycles, the platelet count decreased to 247×103/μl, and we performed laparoscopy-assisted low anterior resection of the rectum. The postoperative course was uneventful and he was discharged on postoperative day 16. Platelet apheresis is a rapid and effective treatment for the control of platelet counts in patients requiring urgent surgery with ET whose medical therapy is ineffective.
