Management Anesthesia in Staghorn Calculus Patient

with Extreme Thrombocytosis

Thomas, Radian
Departement of Anesthesiology And Intensive Care
Faculty of Medicine Padjajaran University – Hasan Sadikin Hospital
Bandung- Indonesia

Introduction:
Extreme thrombocytosis defined as platelet count over 1,000,000 /µL. This case is
uncommon with incidence < 2%. Thrombocytosis can increase risk of excess bleeding or
thrombotic episodes during perioperative period.

Case:
A 72 year old male diagnosed with hydronephrosis sinistra et causa staghorn calculus was
planned for nephrectomy sinistra. This patient was admitted because of massive
haematuria. From anamnesa and physical examination, there was no sign of thrombotic
or bleeding complications. Pre-operative haematological showed platelet count
1,370,000/µL. Direct smear blood morphology showed sign of chronic inflammation
suspected from urinary system. Cefoperazone Sulbactam was administered, no
antiplatelet drugs or anticoagulant was given. General anaesthesia was planned for this
patient. Sign and symptom of bleeding or thrombosis evaluation was done. Intraoperative,
the wound was controlled well, no significant bleeding from drain tube. Postoperative
platelet count showed a downtrend. There was no other investigation and specific therapy
was initiated for thrombocytosis in this patient.

Disscussion:
Principle management of thrombocytosis is treating clinical symptom of bleeding or
thrombosis before surgery, perioperative hydration, thromboprophylaxis. In this case, we
diagnosed patient with reactive thrombocytosis due to chronic urinary infection. It
described by normal morphology of platelet with increased plateled count. No antiplatelet
or thromboprophylaxis is required even with platelet count over 1,000,000/μL unless
additional well-defined thrombophilic symptom are present. General anaesthesia were
chosen by anaesthesiologist. Perioperative period was done uneventful. Post operative
evaluation of thrombocytosis showed downtrend platelet count along with resolution of
infection.

Conclusion:
Preoperative thrombocytosis needs to be acknowledged. Risk of thrombotic or bleeding
investigation, clinical, and haemotological assestment, appropriate perioperative
management strategies should be done comprehensively.

Keyword : Thrombocytosis, thrombotic, anesthesia