Essential Thrombocytosis and having knee surgery

[Kauaiboy]

I am looking for feedback on how this diagnosis will effect a fairly major surgery. I have a need for total knee replacement- have already had arthroscopy on my meniscus and now bone on bone with arthritis on more than 60% of the femur/tibia. It has affected my life such that I want to have this procedure. Being able to walk, play golf, work on our property, explore, participate in life without pain.

I have ET, withe the Jak2 V617F mutation diagnosed 4 months ago and Hydroxyurea has brought my platelets down from 750k to under 300k.

I have a consult with another Hemoc in a few weeks and will ask him about risks and suggestions. I have no cardio issues, no diabetes, normal weight but have had a nephrectomy about 3.5 years ago (renal cell carcinoma- no lymph involvement) and prostate cancer- prostectomy 3 years ago. Unlucky, but grateful to be active and enjoying life with chronic knee pain and swelling.

Several pubmed studies that indicate this knee procedure (quadricep sparing) involves blood loss of approximately 4 pints- I estimate I have about 12 pints of blood volume. I’m not sure what to make of this other than I should be hospitalized until it is safe. The surgeon is located 3000 miles from home necessitating airline flight back after it’s safe to travel. So there’s all that.

In my travels, I met with a Hemoc recently and was told that having normal platelets is important, there’s always a risk of blood clots and that the Jak2 adds another element of risk so I would be put in blood thinners short term to minimize that risk.

Since one can live with orthopedic issues I could avoid this surgery and live with the ramifications that result. However, if the risk is small I’d rather go through with it. Having ET and solo kidney and having a major surgery is certainly more risk. I wish it could be quantified!

I’d like to hear from those that have gone through this or something similar and r4ad your experiences pre and post surgery, your recovery and result, and any questions I should be asking the surgeon, Hemoc, or others.

[hunter5582]

Someone just posted pretty much the same question about a knee surgery. All too common at the age many of us are at. I have torn the meniscus in both knees and have arthritis and deterioration. I am very fortunate that hyaluronic acid injections may postpone the need for knee surgery for quite some time to cone.

I have had other surgeries with blood loss or significant tissue damage. These procedures always have caused reactive thrombocytosis. I have never had thrombosis as a result. It is very important for your MPN Specialist to consult with you and your surgical team when considering a major surgery. That doc can best advise about the specifics of your situation.

It is common for doctors to administer heparin or other anti-clotting agents after some surgeries. The thing to be aware of is that with more elevated levels of thrombocytosis there is also risk of hemorrhage. Your surgery care team needs to be aware of this risk too.

Hope that helps. Good luck with the surgery if you move forward.