A 61-year-old woman with splenomegaly secondary to chronic metamyelocytic leukemia (CMML), a form of myelodysplastic syndrome, was referred to surgery for splenectomy because of symptoms of early satiety and left upper quadrant pain. She was also thrombocytopenic from platelet sequestration and destruction in the enlarged spleen. On the basis of venous collateralization, a diagnosis of splenic vein thrombosis was made.
The scout film shows the enlarges spleen extending down to the top of the iliac crest. Because of a pre-op platelet count of 30,000, one quad pack of platelets was administered prior to the start of the operation. A minimal platelet count of 50,000 is necessary to safely proceed with surgery.
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