Stroke induced by splenectomy in hemoglobin Madrid: autopsy clues to the underlying mechanism

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.