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Though her metastatic disease remained stable, she was repeatedly admitted for symptomatic anaemia and treated by red blood cell and platelet transfusions with increasing frequency as time elapsed. Abdominal examination and ultrasound revealed splenomegaly (27\u2009cm span). A bone marrow biopsy showed fibrosis and foci of metastatic carcinoma. Splenectomy ameliorated her transfusion-dependent anaemia and thrombocytopaenia. Histopathology revealed multiple foci of metastatic carcinoma and scattered foci of extramedullary haematopoiesis. Differential diagnosis of anaemia and thrombocytopaenia in patients with cancer include bone morrow involvement by cancer cells, iron-deficiency anaemia, microangiopathies and chemotherapy suppression of haematopoiesis. Splenic involvement with cancer is common in patients with multivisceral disease. Many may regard transfusion-dependent severe anaemia and thrombocytopaenia as an end-stage disease in these patients. Nevertheless, palliative splenectomy should be considered in patients with possible hypersplenism who will otherwise survive for a relatively prolonged period of time.<\/jats:p>","DOI":"10.1136\/bcr-2017-223453","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T05:45:14Z","timestamp":1545198314000},"page":"e223453","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Splenectomy for breast carcinoma diffusely metastatic to the spleen presenting as severe transfusion-dependent anaemia and thrombocytopaenia"],"prefix":"10.1136","volume":"11","author":[{"given":"Rabea","family":"Hasadia","sequence":"first","affiliation":[{"name":"General Surgery Department, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Kazarin","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orit","family":"Sofer","sequence":"additional","affiliation":[{"name":"Hematology Unit, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katerina","family":"Shulman","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Troitsa","sequence":"additional","affiliation":[{"name":"General Surgery Department, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Alfici","sequence":"additional","affiliation":[{"name":"General Surgery Department, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6305-4159","authenticated-orcid":false,"given":"Itamar","family":"Ashkenazi","sequence":"additional","affiliation":[{"name":"Surgical Oncology Service, Hillel Yaffe Medical Center, Hadera, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"2025082708430111000_11.1.e223453.1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930230311"},{"key":"2025082708430111000_11.1.e223453.2","doi-asserted-by":"crossref","first-page":"965","DOI":"10.5858\/2007-131-965-SMCPDD","article-title":"Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis","volume":"131","author":"Comp\u00e9rat","year":"2007","journal-title":"Arch Pathol Lab Med"},{"key":"2025082708430111000_11.1.e223453.3","first-page":"52","article-title":"Solid splenic masses: evaluation with 18F-FDG PET\/CT","volume":"46","author":"Metser","year":"2005","journal-title":"J Nucl Med"},{"key":"2025082708430111000_11.1.e223453.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2005.12.008"},{"key":"2025082708430111000_11.1.e223453.5","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/00007611-199706000-00010","article-title":"Isolated splenic metastases from colon cancer","volume":"90","author":"Indudhara","year":"1997","journal-title":"South Med J"},{"key":"2025082708430111000_11.1.e223453.6","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.78.917.173"},{"key":"2025082708430111000_11.1.e223453.7","unstructured":"Soff GA , Green DL , Gardner LB . et al Chapter 157: Hematologic manifestations of cancer. 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