Splenic Infarction at the Crossroads of Hematologic and Cardioembolic Risk

Splenic infarction is an uncommon but clinically relevant complication of both hematologic malignancies and cardioembolic disorders. Chronic myeloid leukemia (CML), particularly when associated with hyperleukocytosis and thrombocytosis, contributes to a prothrombotic state. Atrial fibrillation, even in its paroxysmal form, is a well-established risk factor for systemic embolism. When these conditions coexist, thromboembolic risk is significantly elevated, creating complex management challenges due to concurrent bleeding risks. We present a 76-year-old woman with T315I BCR-ABL1 chronic-phase CML, paroxysmal atrial fibrillation, and hypertension who presented with acute left upper quadrant abdominal pain. Imaging studies confirmed splenic infarction. Laboratory findings revealed marked leukocytosis and thrombocytosis. She was treated with intravenous fluids, analgesia, and anticoagulation; initially with heparin infusion, later transitioned to apixaban. Concurrently, disease-directed therapy with asciminib and hydroxyurea led to a partial hematologic response. At three-month follow-up, she remained free of recurrent thrombosis, bleeding, or abdominal symptoms. This case highlights the multifactorial etiology of splenic infarction in patients with overlapping hematologic and cardiovascular risk factors. It underscores the importance of timely imaging for diagnosis and the delicate balance of anticoagulation in the setting of malignancy-associated thrombocytosis. Individualized, multidisciplinary management and careful long-term follow-up are essential to optimize outcomes in this complex patient population.