Thrombo-embolic events, which can be increased after
splenectomy in
hemoglobin disorders, can cause potentially lethal complications. Although
venous thrombosis has been reported, arterial
strokes are rarely reported. A case of
stroke in a 52-year-old patient with a previously performed
splenectomy for known
hemoglobin Madrid, an extremely unstable
hemoglobinopathy, led us to investigate the possible causal role of
splenectomy. The patient had no history of
hypertension,
diabetes mellitus, smoking, or other vascular risk factors--but upon autopsy, thrombotic angiopathy was observed in multiple organs, including the lung, liver, kidney, coronary artery and brain. Bone marrow
hyperplasia was also observed. A thrombotic middle cerebral artery territory
infarction appears to have been caused by chronic recurrent
thrombosis, which may have been a result of the
splenectomy for unstable
hemoglobinopathy. This case supports that
splenectomy be strongly considered as an uncommon risk factor for
stroke.