Abstract
A thirty-nine-year-old male, who complained of tarry stool and anemia, was admitted to the Department of Surgery of Nihon University Hospital in June, 1973. His spleen was enlarged and he showed hematemesis after admission.
A spleen of 1,250 g was resected on June 14 under the diagnosis of Banti's syndrome without examination of platelet count. Then hematemesis did not recur but gingival bleeding appeared two weeks after the removal of spleen. Five days after the splenectomy, the platelet count was 720,000 per mm3 and was raised to 2,750,000 per mm3 in August.
As no tendency of decrease in the platelet count, the patient was referred to the First Department of Internal Medicine for further examination in September, 1973. On the peripheral blood smear many large and small platelets with abundant granules and frequent platelet aggregates were seen. A marrow puncture showed numerous megakaryocytes. On the coagulation studies abnormal platelet aggregation in response to ADP and epinephrin was observed.
Diagnosed as essential thrombocythemia, 274 mg of busulfan was administered in the total dose. Nine months after splenectomy, he was in good condition with platelet count of about 500,000 per mm3 under no therapy.
