SURGERY FOR CHOLECYSTOCHOLEDOCHOLITHIASIS IN A PATIENT WITH ASYMPTOMATIC ESSENTIAL THROMBOCYTHEMIA - REPORT OF A CASE

Essential thrombocythemia (ET) is a myeloproliferative disorder charac terized by a remarkable increase in the platelet count and various cli nical symptoms, The perioperative management of patients with ET has y et to be determined, especially when there are no clinical symptoms, W e report herein the case of a woman with gallstones whose preoperative hematological data showed remarkable thrombocythemia, but her coagula tion studies were normal. The Philadelphia chromosome was negative and bone marrow cytology showed a marked increase in megakaryocytes. Surg ery was performed under a diagnosis of cholelithiasis with ET, Conside ring her severe thrombocythemia and obesity, sufficient heparin was ad ministered to prevent deep vein thrombosis; however, this precipitated postoperative bleeding, necessitating a reoperation. A functional abn ormality of the patient's platelets was suspected, and the aggregation by adenosine diphosphate was subsequently found to be significantly i nhibited. As patients having ET with no symptoms might have depressed platelet aggregability despite remarkable thrombocythemia, when abdomi nal surgery is performed, prophylactic therapy for deep vein thrombosi s should be avoided. Hence, the preoperative aggregation study of plat elets might offer useful information about whether postoperative antit hrombotic therapy is indicated.