Plateletpheresis gives new hope to
a 40-year-old Leukaemia patient

A 40-year-old male patient with a platelet count of 40,000 underwent Bone Marrow Aspiration and was diagnosed with Chronic Myeloid Leukemia. He was started on ecosprin as they have high chances of thrombosis. He also developed a hematoma in the sacral region. He then approached Nanavati Hospital for further management. He was admitted with hemodynamic instability and high lactate levels. He was intubated and vasopressor support was given. The patient was admitted in the ICU under Dr. Ashish Joshi, Consultant Oncologist and was treated as haemorrhagic shock vs sepsis requiring fluids and vasopressors support. The patient continued to have thrombocytosis.

After discussion, the role of Extracorporeal Therapy in the form of Plateletpheresis was considered. Plateletpheresis can be used to treat life-threatening condition due to thrombocytosis, which can lead to thrombosis / bleeding. It works by decreasing the platelet count until the proliferative rates are controlled. This modality is rarely successful in a septic

patient and not widely practised. Left with no choice, after team discussion, Dr. Rinku Bhatia, Head of Department of Transfusion Medicine, decided to start Plateletpheresis. The patient was critically ill owing to Chronic Myeloid Leukemia with thrombocytosis and therefore received three cycles of Plateletpheresis, following which the platelet counts were monitored. There was a significant reduction in the platelet count post Plateletpheresis, which had an additive effect in controlling the proliferative rates resulting in a speedy recovery.

The patient subsequently had improved hemodynamics and was extubated uneventfully. Eventually, he was shifted to the ward. The patient showed good response during the follow-up and is doing fine now. Plateletpheresis, an extracorporeal therapy, is a useful adjunct and may be considered to treat life-threatening manifestations of thrombocytosis until the proliferative rates are controlled in such cases of Chronic Myeloid Leukemia.

Dr. Abdul Samad

Dr. Abdul Samad
Critical Care Services
Nanavati Super
Speciality Hospital