Portal vein thrombosis in a case of chronic myeloid leukemia- a rare association

ABSTRACT

Chronic Myeloid Leukemia [CML] in absence of hyperleukocytosis is an unusual cause for hepatic vein thrombosis. We present a case of hepatic vein thrombosis that presented with abdominal pain, vomiting and splenomegaly. Ultrasound and Doppler study findings indicated hepatic vein thrombosis. His thrombophilia profile was normal. However he had slightly raised platelet count and mild leukocytosis at that time. He showed improvement on anticoagulant therapy. However after two years he presented with weakness and was suggested bone marrow biopsy and cytogenetic studies. The findings of these tests were in favour of CML in chronic phase and cytogenetic studies revealed Philadelphia positivity. He was not evaluated for thrombocythemia though he had raised platelet count at the time of presentation. He is now receiving treatment for CML. It is proposed that the patient may have developed essential thrombocythemia in addition to Philadelphia positive CML, thereby making the patient prone to thrombotic episodes even at an early stage of CML. Unfortunately he could not be evaluated for JAK-2 mutation at any stage. It is suggested that in absence of hyperleukocytosis patients with history of thrombosis should be evaluated for myeloproliferative disorders [MPDs] as treatment for these disorders itself reduces the size of thrombus