A CASE OF PRIMARY MYELOFIBROSIS SUSPECTED OF TERMINATING IN LEUKEMIA AFTER SPLENECTOMY

We experienced a case of primary myelofibrosis (PMF) suspected of terminating in leukemia after splenectomy. A 70-year-old man who was in hospital because of chronic anemia and thrombocytopenia was diagnosed as having primary myelofibrosis (PMF) on close examination. Thereafter, left lateral abdominal pain and appetite loss appeared and abdominal ultrasonography and CT scan revealed the giant spleen. Because of unsuccessful blood transfusions for his anemia and oppressed symptoms of the stomach due to the huge spleen, a splenectomy was carried out. After the splenectomy, the platelet count increased but no remission of anemia was attained. Five months later, WBC increased to 136, 700/mm3 and the percentage of myeloblast in peripheral blood increased to 78.0%, and then the patient died. So we suspected that it was terminated in leukemia after the splenectomy. A few cases have been reported that primary myelofibrosis terminated in leukemia after splenectomy, and splenectomy may have a risk to enhance the characteristic of primary myelofiblosis as “myeloproliferative disorders”. We have to be more considerate of indication about surgical therapy for primary myelofibrosis.