Recurrent arterial thrombosis of the lower extremity with secondary thrombocythemia due to reperfusion injury: a case report

Thrombocythemia is an important cause for thrombogenesis and can be classified as essential or secondary according to the etiology. Secondary thrombocythemia (ST), also called reactive thrombocytosis, is caused by a disorder that triggers increased production by normal platelet-forming cells and is characterized in terms of abnormal increased number of platelet in blood and megakaryocytes in bone marrow. Previous reports have found that complications from malignant tumors, chronic inflammation, acute inflammation, acute hemorrhage, spleen resection etc. to be the common causes of ST. A 53-year-old Chinese male with right lower limb arterial ischemic embolism developed recurring arterial thrombosis at the previous site after operation. During his hospitalization, the patient had a platelet count that was positively correlated with alanine transaminase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase (CK), and creatine kinase isoenzyme MB (CK-MB) while his thromboelastogram (TEG) and platelet aggregation test obtained by sequential platelet count showed inconsistent platelet function. We describe a case in which ischemia-reperfusion injury caused ST and recurrent thrombosis and analyse the probable cause of contradictory results of different platelet function tests. In thrombolytic therapy, we recommend adding platelet count and two more platelet aggregation tests to the routine laboratory items to aid in the prevention of recurrent thrombosis.